Compromiso de arteria renal en paciente con arteritis de Takayasu: reporte de caso y revisión de literatura

Introducción: La arteritis de Takayasu (TAK) es una enfermedad idiopática granulomatosa de grandes vasos que afecta predominantemente a la aorta, ramas arteriales principales y pulmonares. La prevalencia es mayor en adultos que en niños, con una incidencia de 1,1 por millón de personas. Su etiología sigue siendo poco conocida. Caso Clínico: Se presenta el caso de un paciente pediátrico con pérdida de la masa renal izquierda por disminución del calibre de arteria renal ipsilateral meses después del debut de la Arteritis de Takayasu como aneurisma de aorta abdominal. El paciente cumple criterios de TAK según clasificación EULAR/PRINTO/PReS basados en anomalía angiográfica, hipertensión arterial y elevación reactantes de fase aguda. La TAK presenta afectación sistémica y alteraciones cardiovasculares (75-85%), hipertensión en más del 80% de los casos, con estenosis de la arteria renal en casi el 50% de los pacientes. Conclusiones: El tratamiento general de la TAK está dirigido a controlar la inflamación vascular y prevenir el daño orgánico irreversible. A pesar de un diagnóstico temprano con tratamiento oportuno y agresivo el seguimiento en la enfermedad de Takayasu es imprescindible dado que la progresión de esta puede seguirse dando. Deben establecerse estrategias para asegurar la adherencia al seguimiento. (provided by Infomedic Intl.)

Introduction: Takayasu's arteritis (TAK) is an idiopathic granulomatous large vessel disease predominantly affecting the aorta, main arterial branches and pulmonary arteries. The prevalence is higher in adults than in children, with an incidence of 1.1 per million people. Its etiology remains poorly understood. Case Report: We present the case of a pediatric patient with loss of left renal mass due to decreased ipsilateral renal artery caliber months after the debut of Takayasu's arteritis as abdominal aortic aneurysm. The patient meets TAK criteria according to EULAR/PRINTO/PReS classification based on angiographic abnormality, arterial hypertension and elevated acute phase reactants. TAK presents systemic involvement and cardiovascular alterations (75-85%), hypertension in more than 80% of cases, with renal artery stenosis in almost 50% of patients. Conclusions: The general treatment of TAK is aimed at controlling vascular inflammation and preventing irreversible organ damage. Despite early diagnosis with timely and aggressive treatment, follow-up in Takayasu's disease is imperative as progression may still occur. Strategies should be established to ensure adherence to follow-up. (provided by Infomedic Intl.)

Task force of the Brazilian Society of Otology — evaluation and management of peripheral facial palsy

Abstract Objective To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. Methods Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. Conclusions Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

Comparison of speech changes caused by four different orthodontic retainers: a crossover randomized clinical trial

ABSTRACT Objective: This study aimed to compare the influence of four different maxillary removable orthodontic retainers on speech. Material and Methods: Eligibility criteria for sample selection were: 20-40-year subjects with acceptable occlusion, native speakers of Portuguese. The volunteers (n=21) were divided in four groups randomized with a 1:1:1:1 allocation ratio. The four groups used, in random order, the four types of retainers full-time for 21 days each, with a washout period of 7-days. The removable maxillary retainers were: conventional wraparound, wraparound with an anterior hole, U-shaped wraparound, and thermoplastic retainer. Three volunteers were excluded. The final sample comprised 18 subjects (11 male; 7 female) with mean age of 27.08 years (SD=4.65). The speech evaluation was performed in vocal excerpts recordings made before, immediately after, and 21 days after the installation of each retainer, with auditory-perceptual and acoustic analysis of formant frequencies F1 and F2 of the vowels. Repeated measures ANOVA and Friedman with Tukey tests were used for statistical comparison. Results: Speech changes increased immediately after conventional wraparound and thermoplastic retainer installation, and reduced after 21 days, but not to normal levels. However, this increase was statistically significant only for the wraparound with anterior hole and the thermoplastic retainer. Formant frequencies of vowels were altered at initial time, and the changes remained in conventional, U-shaped and thermoplastic appliances after three weeks. Conclusions: The thermoplastic retainer was more harmful to the speech than wraparound appliances. The conventional and U-shaped retainers interfered less in speech. The three-week period was not sufficient for speech adaptation.

RESUMO Objetivo: Este estudo teve como objetivo comparar a influência na fala causada por quatro diferentes contenções ortodônticas removíveis superiores. Material e Métodos: Os critérios de elegibilidade para seleção da amostra foram: indivíduos com 20 a 40 anos de idade, com oclusão aceitável, falantes nativos de português. Os voluntários (n=21) foram divididos em quatro grupos, randomizados com proporção de alocação de 1:1:1:1. Os quatro grupos utilizaram os quatro tipos de contenção, em ordem aleatória e em período integral por 21 dias cada, com período de wash-out de sete dias. As contenções superiores removíveis foram: wraparound convencional, wraparound com orifício anterior, wraparound em U e contenção termoplástica. Três voluntários foram excluídos. A amostra final foi composta por 18 indivíduos (11 homens; 7 mulheres) com idade média de 27,08 anos (DP=4,65). A avaliação da fala foi realizada em gravações de trechos vocais, realizadas antes, imediatamente após e 21 dias após a instalação de cada contenção, com análise perceptivo-auditiva e acústica das frequências formantes F1 e F2 das vogais. ANOVA de medidas repetidas e teste de Friedman com Tukey foram utilizados para comparação estatística. Resultados: As alterações de fala aumentaram imediatamente após a instalação das contenções wraparound e termoplástica, e reduziram após 21 dias, mas não para níveis normais. Porém, esse aumento foi estatisticamente significativo apenas para as contenções wraparound com orifício anterior e termoplástica. As frequências dos formantes das vogais foram alteradas no momento inicial e, após três semanas, as alterações se mantiveram com as contenções convencional, em forma de U e termoplástica. Conclusões: A contenção termoplástica foi mais prejudicial à fala do que os aparelhos wraparound. Oswraparounds convencional e em forma de U interferiram menos na fala. O período de três semanas não foi suficiente para adaptação da fala.

Una aplicación móvil de ayuda para estudiantes de epidemiología: evaluación preliminar de EpiApp

Introducción: Las aplicaciones móviles (Apps) están transformando las perspectivas de aprendizaje en entornos de salud. Objetivo: Evaluar la efectividad y usabilidad de EpiApp como herramienta de apoyo en la consulta y resolución de problemas de epidemiología comparada con métodos tradicionales (MT). Materiales y métodos: Se diseñó EpiApp usando una estructura metodológica. Se realizó un estudio experimental controlado y aleatorizado con dos grupos: EpiApp y MT. La fectividad se evaluó con un cuestionario estandarizado y la usabilida con la escala MARS. Resultados: Se aleatorizaron 176 estudiantes: EpiApp (n=88) y MT (n=88). El tiempo de respuesta fue menor para los usuarios de EpiApp (23,99 min [± DE 8,38] vs. 29,16 min [± DE 11,61], p = 0,005). No hubo diferencias en el número de respuestas correctas (p = 0,635), ni en la oportunidad de aprobar el cuestionario (p = 0,054). La usabilidad fue buena (MARS > 4). Discusión: Las Apps móviles tienen un gran potencial para ser útiles en la educación en salud y en la toma de decisiones en epidemiología, así como en la atención médica en general. No obstante, es esencial realizar estudios rigurosos para garantizar que estas aplicaciones sean efectivas, útiles, fáciles de usar y comprender. Conclusiones: EpiApp redujo el tiempo de respuesta en la resolución de problemas de epidemiología sin afectar el número de respuestas correctas. La usabilidad fue buena, aunque hay oportunidad de mejora en diversión, interés, adaptabilidad individual e interactividad. La efectividad y usabilidad de EpiApp requiere ser validada con estudios más rigurosos y en diferentes contextos.

Introduction: Mobile applications (Apps) are transforming learning perspectives in healthcare settings. Objective: To evaluate the effectiveness and usability of EpiApp as a support tool in the consultation and resolution of epidemiology problems, compared to traditional methods (TM). Methodology: EpiApp was designed using a methodological structure. A randomized controlled experimental study was conducted with two groups: EpiApp and TM. A standardized questionnaire and the MARS scale were used to evaluate effectiveness and usability, respectively. Results: A total of 176 students were randomized: EpiApp (n=88) and TM (n=88). Response time was shorter for EpiApp users (23.99 min [±SD 8.38] vs. 29.16 min [±SD 11.61], p=0.005). There were no differences in the number of correct responses (p=0.635) or the opportunity to pass the questionnaire (p=0.054). Usability was good (MARS>4). Discussion: Mobile Apps have great potential to be useful in healthcare education and decision-making in epidemiology, as well as in general medical care. However, it is essential to conduct rigorous studies to ensure that these applications are effective, useful, and easy to use and understand. Conclusions: EpiApp reduced response time in solving epidemiology problems without affecting the number of correct answers. The usability was good, although there is room for improvement in terms of enjoyment, interest, individual adaptability, and interactivity. The effectiveness and usability of EpiApp need to be validated through more rigorous studies in different contexts.

Hallazgo incidental de neoplasia primaria de pulmón: blastoma pulmonar en mujer adulta. Reporte de caso / Incidental finding of primary lung neoplasm: pulmonary blastoma in an adult woman, case report

El blastoma pulmonar es una neoplasia poco común y agresiva que se origina en el pulmón; está compuesto por tejido mesenquimal y epitelial inmaduro que imita la configuración pulmonar en etapas embrionarias. Tiene una baja incidencia y una alta tasa de mortalidad, con aproximadamente un 60 %. Este blastoma tiende a desarrollarse con mayor frecuencia entre la cuarta y quinta década de vida, siendo más prevalente en mujeres y generalmente asociado al tabaquismo. Se presenta el caso de una mujer de 23 años sin factores de riesgo conocidos, a quien se le diagnosticó incidentalmente un blastoma pulmonar primario. La paciente experimentaba dolor en la región costal izquierda, tos productiva, disnea y hemoptisis desde hace 30 días. Los hallazgos en las imágenes de rayos X y tomografías de tórax llevaron a la realización de una biopsia del pulmón izquierdo, que reveló fragmentos de tejido con una notable presencia de necrosis tumoral. Cinco días después, la paciente consultó nuevamente debido a un empeoramiento de los síntomas, incluyendo dolor torácico de tipo pleurítico. Se decidió realizar una lobectomía inferior izquierda, durante la cual se encontró un tumor sólido adherido a la pleura visceral, con masas tumorales en la pleura parietal. El estudio histopatológico final confirmó el diagnóstico de un tumor maligno de alto grado compatible con blastoma pulmonar. En conclusión, el blastoma pulmonar es una neoplasia rara que puede presentarse en diferentes etapas de la vida, aunque tiene mayor incidencia entre los 40 y 50 años. Es importante que los patólogos consideren esta enfermedad en sus diagnósticos diferenciales debido a los desafíos que implica su diagnóstico. Detectar el blastoma pulmonar en etapas tempranas es crucial para el tratamiento adecuado, aunque actualmente no se conocen marcadores predictivos confiables y el pronóstico de esta enfermedad es generalmente desfavorable.

Pulmonary blastoma is a rare and aggressive neoplasm that originates in the lung. It is composed of immature mesenchymal and epithelial tissue that mimics the embryonic configuration of the lung. It has a low incidence and a high mortality rate, of approximately 60%. Pulmonary blastoma tends to occur more frequently between the fourth and fifth decades of life, being more prevalent in women and generally associated with smoking. The case of a 23-year-old woman with no known risk factors is presented, who incidentally was diagnosed with a primary pulmonary blastoma. The patient experienced pain in the left costal region, productive cough, dyspnea, and hemoptysis for 30 days. Findings on X-ray and chest tomography led to a biopsy of the left lung, which revealed tissue fragments with significant tumor necrosis. Five days later, the patient consulted again due to worsened symptoms, including pleuritic chest pain. It was decided to perform a left lower lobectomy, during which a solid tumor attached to the visceral pleura with tumor masses in the parietal pleura was found. The final histopathological study confirmed the diagnosis of a high-grade malignant tumor compatible with pulmonary blastoma. In conclusion, pulmonary blastoma is a rare neoplasm that can occur at different stages of life, although it has a higher incidence between the ages of 40 and 50. Pathologists need to consider this disease in their differential diagnoses due to the challenges involved in its diagnosis. Detecting pulmonary blastoma at early stages is crucial for appropriate treatment, although currently there are no reliable predictive markers, and the prognosis of this disease is generally unfavorable.

Encefalitis por SARS-CoV-2 asociado a debut de Lupus Eritematoso Sistémico

A través del tiempo se han identificado distintos virus, con efectos nocivos sobre el sistema nervioso central, provocando alteraciones permanentes o transitorias de sus funciones. Reportes previos, derivados del SARS del 2002 y del MERS-CoV del 2012, sugieren que el coronavirus tiene como presentación atípica compromiso neurológico, ya que tiene capacidad neuroinvasora y neurotrópica, pudiendo ocasionar polineuropatías, convulsiones, psicosis o incluso promover accidentes cerebrovasculares. A través de este artículo, se da a conocer el caso de una paciente de 16 años, con alteraciones neurológicas y reumatológicas asociadas a infección por virus SARS-CoV-2, así como la importancia del reconocimiento oportuno del cuadro clínico, ayudas diagnósticas, evolución, diagnóstico, tratamiento y complicaciones. (provisto por Infomedic International)

Over time, different viruses have been identified with harmful effects on the central nervous system, causing permanent or transitory alterations of its functions. Previous reports, derived from SARS in 2002 and MERS-CoV in 2012, suggest that the coronavirus has neurological involvement as an atypical presentation, since it has neuroinvasive and neurotropic capacity, and can cause polyneuropathies, seizures, psychosis or even promote cerebrovascular accidents. This article reports the case of a 16-year-old patient with neurological and rheumatological alterations associated with SARS-CoV-2 virus infection, as well as the importance of timely recognition of the clinical picture, diagnostic aids, evolution, diagnosis, treatment and complications. (provided by Infomedic International)

Percepción de la calidad de vida de personas receptoras de trasplante renal en etapas temprana y tardía / Quality of life in kidney transplant recipients in early and late stages: a qualitative study

Introducción: la enfermedad renal crónica incluye diversos tratamientos, el trasplante renal es el procedimiento electivo debido a la mejora de la calidad de vida y la supervivencia frente a otros tratamientos. El paciente experimenta situaciones abrumadoras por la complejidad que implica la adaptación. Objetivo: comparar la percepción de calidad de vida postrasplante en la etapa temprana y tardía en cuatro dimensiones. Metodología: estudio con enfoque cualitativo, aplicación del diseño fenomenológico con alcance de saturación de categorías. La calidad de vida se enfocó en cuatro dimensiones: bienestar físico, bienestar emocional, relaciones interpersonales y bienestar material. Se utilizó la herramienta Atlas ti V.20 para capturar datos, evaluar y visualizar las relaciones entre entrevistas para crear redes semánticas. Resultados: se entrevistó a 10 personas sobre su percepción de calidad de vida posterior al trasplante renal en la etapa temprana y tardía, independientemente de su situación funcional, social, psicológica y económica. Conclusiones: la calidad de vida percibida en las personas receptoras de trasplante renal son el constructor de sus actividades y su reintegración a ellas, preservando hechos como el mantenimiento de su estado de salud, vínculo de sus relaciones y producción laboral. Estudiar dicha percepción ampliada en las dimensiones estudiadas describen mejor el estado progresivo en la recuperación... (AU)

Introduction: Chronic kidney disease includes various treatments, Kidney Transplantation is the elective procedure, due to the improvement in quality of life and survival compared to other treatments. The patient experiences overwhelming situations due to the complexity that adaptation implies. Objective: To compare the perception of quality of life after transplantation in the early and late stages in four dimensions. Methodology: Study with a qualitative approach, application of the phenomenological design with a scope of saturation of categories, it is worth mentioning that the quality of life was focused on four dimensions: physical well-being, emotional well-being, interpersonal relationships and material well-being. The tool Atlas ti V.20 was used to capture data, evaluate and visualize the relationships between interviews to create semantic networks. Results: 10 patients were interviewed about the perception of quality-of-life post-transplant improvement in early and late stages, regardless of their functional, social, psychological and economic situation; Conclusions: The perceived quality of life in kidney transplant recipients is the construct of their activities and their reintegration into them, preserving facts such as the maintenance of their state of health, the bond of their relationships and labor production. Studying this expanded perception in the dimensions studied better describe the progressive state in recovery.

Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment

Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Actitud del personal de enfermería ante COVID-19 en Querétaro y Yucatán / Nursing staff attitude towards COVID-19 in Querétaro and Yucatán

Introducción: esta investigación describe la actitud del personal de enfermería que ha laborado en el área de atención COVID-19 durante el año 2021 en los estados de Querétaro y Yucatán, México. La actitud ante la COVID-19 es la variable fundamental en el comportamiento que puede presentar un individuo, es un estado de disposición mental el cual permite influenciar la conducta, esta se ve afectada por las creencias y valores que se han aprendido a lo largo de la vida. Objetivo: comparar la actitud del personal de enfermería que otorga cuidados a pacientes con COVID-19 en Querétaro y Yucatán. Metodología: estudio descriptivo, transversal, cuantitativo en una muestra de 292 personal de enfermería por muestreo no probabilístico, con la adaptación del instrumento "Conocimiento, actitud, práctica y respuesta psicológica entre enfermeras durante COVID-19", el cual se tradujo y contextualizó en español obteniendo indicadores de confiabilidad (alfa de Cronbach de 0.75) y se cuidó la validez de contenido para analizar las variables del presente estudio. Resultados: los participantes corresponden a 130 de Querétaro y 162 de Yucatán, pudo observarse que la mayor proporción de actitud favorable corresponde a Yucatán, no obstante, las diferencias entre las dos muestras no son estadísticamente significativas (p = 0.382). Conclusión: se determinó que los profesionales de enfermería tuvieron una actitud favorable en la atención de los pacientes con COVID-19.

Introduction: This research describes the attitude of nursing personnel who have worked in the COVID-19 care area during the year 2021 in the states of Querétaro and Yucatán, Mexico. The attitude towards COVID-19 is the fundamental variable in the behavior that an individual can present, it is a state of mental disposition, which allows influencing behavior, and this is affected by the beliefs and valuesthat have been learned throughout life. Objective: To compare the attitude of the nursing staff who provide care to patients with COVID-19 in Querétaro and Yucatán. Methodology: Descriptive, cross-sectional, quantitative study in a sample of 292 nursing staff by non-probabilistic sampling, with the adaptation of the instrument "Knowledge, attitude, practice and psychological response towards COVID-19 among nurses during the COVID-19 outbreak" was translated and contextualized in Spanish, obtaining reliability indicators (Cronbach's Alpha: 0.75) and content validity was taken care of to analyze the variables of this study. Results: The participants correspond to 130 from Querétaro and 162 from Yucatán, it could be observed that the highest proportion of favorable attitude corresponds to Yucatán, however, the differences between the two samples were not statistically significant (p = 0.382). Conclusion: it was determined that nursing professionals had a favorable attitude in the care of patients with COVID-19.

Consenso colombiano de la enfermedad inflamatoria intestinal pediátrica

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Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.

Factores asociados al tratamiento no exitoso para tuberculosis en pacientes previamente tratados en Cali, Colombia, en el periodo 2015-2019 / Factors associated with unsuccessful treatment outcome for tuberculosis in previously treated patients in Cali, Colombia, during the period 2015-2019

Introducción. Las tasas de éxito del tratamiento de la tuberculosis continúan siendo subóptimas. Objetivo. Identificar los factores asociados al tratamiento no exitoso para tuberculosis en pacientes con antecedentes de tratamiento para la tuberculosis. Materiales y métodos. Se realizó un estudio observacional retrospectivo, analítico, de cohorte de pacientes que reingresaron a un programa de micobacterias en Cali, Colombia. Se incluyeron mayores de 15 años con tuberculosis pulmonar entre el 2015 y el 2019 con antecedentes de tratamiento para la tuberculosis. Se excluyeron los pacientes con tuberculosis resistente. Resultados. Ingresaron 605 pacientes con antecedentes de tratamiento, 60 % por tratamiento inconcluso y 40 % por recaída. En comparación con los pacientes que reingresaron por recaída (ORa= 2,34; IC=1,62-3,38), las variables que explicaron de manera independiente el no tener éxito con el tratamiento para la tuberculosis al egreso fueron: estar en situación de calle (ORa = 2,45; IC = 1,54-3,89), ser farmacodependiente (ORa = 1,95; IC=1,24-3,05), tener coinfección tuberculosis/VIH (ORa = 1,69; IC =1,00- 2,86) o diabetes (ORa =1,89; IC=1,29-2,77), y el incumplimiento de un tratamiento previo por pérdida de seguimiento, abandono u otras causas. Las variables programáticas que favorecieron el éxito del tratamiento fueron la asesoría de la prueba voluntaria de VIH (p < 0,001) y la realización de la prueba de VIH (p < 0,001). Conclusión. Estar en situación de calle, ser farmacodependiente, tener coinfección de tuberculosis y VIH, o diabetes, así como el incumplimiento del tratamiento previo por pérdida del seguimiento, abandono o fracaso del mismo, dificultaron el éxito del tratamiento antituberculoso. En la primera atención al reingreso de los pacientes con tuberculosis se deben identificar y abordar estas características.

Introduction. The success rates in the treatment of tuberculosis are suboptimal. Objective. To identify associated factors with the lack of success of antituberculosis treatment in patients with a tuberculosis treatment history. Materials and methods. We performed a retrospective, analytical, observational, and cohort study of patients reentering the Mycobacterium program in Cali, Colombia. We included patients over 15 years old with pulmonary tuberculosis between 2015 and 2019 and a history of tuberculosis treatment. Patients with drug-resistant tuberculosis were excluded. Results. A total of 605 patients with a treatment history were included, 60% due to unfinished treatment and 40% due to relapse. Compared to patients reentering due to relapse (ORa=2.34, CI=1.62-3.38), the independent variables associated with treatment failure at discharge were homelessness (ORa=2.45, CI=1.54-3.89), substance dependence (ORa=1.95, CI=1.24-3.05), tuberculosis/HIV coinfection (ORa=1.69, CI=1.00-2.86), diabetes (ORa=1.89, CI=1.29-2.77), and unfinished previous tuberculosis treatment due to follow-up loss, abandonment, or other causes. Programmatic variables favoring treatment success were voluntary HIV testing counseling (p<0.001) and HIV testing (p<0.001). Conclusion. Homelessness, substance dependence, tuberculosis/HIV coinfection, diabetes, and incomplete previous treatment due to loss to follow-up, abandonment, or treatment failure hindered the success of antituberculosis. These characteristics should be identified and addressed during the initial care of patients reentering treatment for tuberculosis.

Aprendizaje automático aplicado a la predicción de diabetes mellitus, utilizando información socioeconómica y ambiental de usuarios del sistema de salud

Objetivo: Se propuso aplicar modelos basados en técnicas de aprendizaje automático como apoyo para el diagnóstico temprano de la diabetes mellitus, utilizando variables de datos ambientales, sociales, económicos y sanitarios, sin la dependencia de la toma de muestras clínicas. Metodología: Se utilizaron datos de 10 889 usuarios afiliados al régimen subsidiado de salud de la zona suroccidental en Colombia, diagnosticados con hipertensión y agrupados en usuarios sin (74,3 %) y con (25,7 %) diabetes mellitus. Se entrenaron modelos supervisados utilizando k vecinos más cercanos, árboles de decisión y bosques aleatorios, así como modelos basados en ensambles, aplicados a la base de datos antes y después de balancear el número de casos en cada grupo de diagnóstico. Se evalúo el rendimiento de los algoritmos mediante la división de la base de datos en datos de entreno y de prueba (70/30, respectivamente), y se utilizaron métricas de exactitud, sensibilidad, especificidad y área bajo la curva. Resultados: Los valores de sensibilidad aumentaron considerablemente al utilizar datos balanceados, pasando de valores máximos del 17,1 % (datos sin balancear) a valores de hasta 57,4 % (datos balanceados). El valor más alto de área bajo la curva (0,61) fue obtenido con los modelos de ensambles, al aplicar un balance en el número de datos por cada grupo y al codificar las variables categóricas. Las variables de mayor peso estuvieron asociadas con aspectos hereditarios (24,65 %) y con el grupo étnico (5.59 %), además de la dificultad visual, el bajo consumo de agua, una dieta baja en frutas y verduras, y el consumo de sal y azúcar. Conclusiones: Aunque los modelos predictivos, utilizando información socioeconómica y ambiental de las personas, surgen como una herramienta para el diagnóstico temprano de la diabetes mellitus, estos aún deben ser mejorados en su capacidad predictiva.

Objective: The objective was to apply models based on machine learning techniques to support the early diagnosis of diabetes mellitus, using environmental, social, economic and health data variables, without dependence on clinical sample collection. Methodology: Data from 10,889 users affiliated with the subsidized health system in the southwestern area of Colombia, diagnosed with hypertension and grouped into users without (74.3%) and with (25.7%) diabetes mellitus, were used. Supervised models were trained using k-nearest neighbors, decision trees, and random forests, as well as ensemble-based models, applied to the database before and after balancing the number of cases in each diagnostic group. The performance of the algorithms was evaluated by dividing the database into training and test data (70/30, respectively), and metrics of accuracy, sensitivity, specificity, and area under the curve were used. Results: Sensitivity values increased significantly when using balanced data, going from maximum values of 17.1% (unbalanced data) to values as high as 57.4% (balanced data). The highest value of area under the curve (0.61) was obtained with the ensemble models, by applying a balance in the amount of data for each group and by coding the categorical variables. The variables with the greatest weight were associated with hereditary aspects (24.65%) and with the ethnic group (5.59%), in addition to visual difficulty, low water consumption, a diet low in fruits and vegetables, and the consumption of salt and sugar. Conclusions: Although predictive models, using people's socioeconomic and environmental information, emerge as a tool for the early diagnosis of diabetes mellitus, their predictive capacity still needs to be improved.

Objetivo: Propôs-se aplicar modelos baseados em técnicas de aprendizagem automática como apoio para o diagnóstico precoce da diabetes mellitus, utilizando variáveis de dados ambientais, sociais, econômicos e sanitários, sem a dependência da coleta de amostras clínicas. Metodologia: Usaram-se dados de 10.889 usuários filiados ao regime subsidiado de saúde da zona sudoeste da Colômbia, diagnosticados com hipertensão e agrupados em usuários sem (74,3%) e com (25,7%) diabetes mellitus. Foram treinados modelos supervisionados utilizando k vizinhos mais próximos, árvores de decisão e florestas aleatórias, assim como modelos baseados em montagens, aplicados à base de dados antes de depois de equilibrar o número de casos em cada grupo de diagnóstico. Avaliou-se o desempenho dos algoritmos por meio da divisão da base de dados de treino e teste (70/30, respectivamente), e utilizaram-se métricas de exatidão, sensibilidade, especificidade e área sob a curva. Resultados: Os valores de sensibilidade aumentaram de maneira significativa ao utilizar dados equilibrados, passando de valores máximos de 17,1% (dados sem equilibrar) a valores de até 57,4% (dados equilibrados). O valor mais elevado de área sob a curva (0,61) foi obtido com os modelos de montagens, ao aplicar um balanço no número de dados por cada grupo e codificar as variáveis categóricas. As variáveis de maior peso estiveram associadas com fatores hereditários (24,65%) e com o grupo étnico (5,59%), além da dificuldade visual, o baixo consumo de água, um regime baixo em frutas e vegetais e o consumo de sal e açúcar. Conclusões: Embora os modelos preditivos, utilizando informação socioeconômica e ambiental das pessoas, surgem como uma ferramenta para o diagnóstico precoce da diabetes mellitus, ainda devem ser melhorados em sua capacidade preditiva.

Aspectos clínico-epidemiológicos en pacientes con abscesos odontogénicos cervicofaciales y factores asociados para estancia hospitalaria corta / Clinical-epidemiological aspects in patients with cervicofacial odontogenic abscesses and associated factors for short hospital stay

Introducción: en todo paciente hospitalizado con absceso odontogénico cervicofacial se busca resolución pronta del absceso, pero es necesario conocer cuáles son los factores que favorecen la resolución en hospitalizaciones cortas (1-3 días). Objetivo: determinar factores clínico-epidemiológicos de pacientes con abscesos odontogénicos para identificar factores que correlacionan con hospitalización corta. Material y métodos: estudio transversal, retrospectivo, observacional y analítico de 100 pacientes con abscesos odontogénicos en un Hospital General de Zona del Instituto Mexicano del Seguro Social de los años 2012-2013. Variables de estudio: días de hospitalización, sexo, edad, comorbilidades, conteo leucocitario, trismus, diente causal, región afectada y tratamientos realizados. Tamaño de muestra obtenido con fórmula para estudios observaciones con manejo de prevalencias para poblaciones infinitas, se empleó χ2 para identificar factores que correlacionan con hospitalización corta. Resultados: mujeres 56%, rango de edad 12-89 años y de hospitalización de 1-23 días; con comorbilidades 56%, leucocitosis 39% y trismus 21%. La caries causó 64% de abscesos, molares inferiores 70% y región submandibular afectada 73%. Variables estadísticamente significativas; conteo leucocitario, diente causal y región afectada. Conclusión: factores correlacionados con hospitalización corta: conteo leucocitario menor a 10,500 leucocitos, que el molar inferior no sea el diente causal y que la región submandibular no esté afectada (AU)

Introduction: prompt resolution of the abscess is sought in all patients hospitalized with cervicofacial odontogenic abscess, but which factors favor this resolution in short hospitalizations (1-3 days). Objective: determine clinical-epidemiological factors of patients with odontogenic abscesses to identify factors that correlate with short hospitalization. Material and methods: crosssectional, retrospective, observational and analytical study of 100 patients with odontogenic abscesses in a General Hospital of the Zone of the Mexican Social Security Institute from 2012-2013. Study variables; days of hospitalization, sex, age, comorbidities, leukocyte count, trismus, causative tooth, affected region and treatments performed. Sample size obtained with the formula for observational studies with prevalence management for infinite populations, χ2 was used to identify factors that correlate with short hospitalization. Results: women 56%, age range 12-89 years and hospitalization of 1-23 days, with comorbidities 56%, leukocytosis 39% and trismus 21%. Caries caused 64% of abscesses, lower molars 70% and affected submandibular region 73%. Statistically significant variables; leukocyte count, causative tooth and affected region. Conclusion: factors correlated with short hospitalization; leukocyte count less than 10,500 leukocytes, that the lower molar is not the causal tooth and that the submandibular region is not affected.

Comparison of the indicative of muscle dysmorphia among recreational and competitive Crossfit athletes / Comparação do indicativo de dismorfia muscular entre atletas recreacionais e competitivos de Crossfit

Abstract This cross-sectional study compared the indicative of Muscle dysmorphia in CrossFit athletes. Participants were 276 male and female CrossFit athletes with an average age of 28.56 ± 8.08 years. A questionnaire was used with questions about age, practice time and frequency of Crossfit practice, as well as the questionnaire of the Adonis complex. Data analysis was conducted through Kolmogorov-Smirnov and Mann-Whitney tests, and Spearman correlation (p<0.05). The adopted significance was p<0.05. The results showed that men obtained higher indicative of muscle dysmorphia in comparison to women as well as competitive athletes showed higher score than recreational athletes (p<0.05). It was found significant (p<0.05) and negative correlation of the indicative of muscle dysmorphia with training frequency (Rho=-0.51) among recreational athletes, and positive correlation (Rho=0.19) among competitors. It is concluded that being male and having a competitive profile are actors in the presence of Muscle dysmorphia in CrossFit athletes.

Resumo Este estudo transversal comparou o indicativo de dismorfia muscular em praticantes de crossfit. Participaram da pesquisa 276 praticantes de CrossFit, de ambos os sexos, com idade média de 28,56 ± 8,08 anos. Utilizou-se um questionário com perguntas sobre idade, tempo e frequência da prática do Crossfit, além do questionário do complexo Adonis. A análise de dados foi conduzida por meio dos testes de Kolmogorov-Smirnov e Mann-Whitney, e a correlação de Spearman (p<0,05). Os resultados evidenciaram que os homens apresentaram maior indicativo de dismorfia muscular em quando comparados às mulheres assim como os competidores apresentaram escores superiores do que os praticantes recreacionais (p<0,05). Verificou-se correlação significativa (p<0,05) e negativa do indicativo de dismorfia muscular com a frequência de treinamento (Rho=-0.51) entre os praticantes recreacionais, e correlação positiva (Rho=0.19) entre os competidores. Concluiu-se que ser homem e ter um perfil competitivo são fatores que podem desencadear a dismorfia muscular em praticantes de crossfit.

Teratoma de ligamento redondo, reporte de caso y revisión de la bibliografía / Round ligament teratoma, case report and literature review

Resumen ANTECEDENTES: El teratoma es un tumor casi siempre benigno, con una amplia variabilidad en su localización, extremadamente rara, en el ligamento redondo. CASO CLÍNICO: Paciente de 30 años, con antecedente de un embarazo a término. En la revisión ecográfica se reportó una lesión quística paraovárica izquierda de 46 x 35 mm, sin componente sólido, graso ni calcificaciones. En el examen ginecológico se palpó una masa por encima del útero, orientada hacia el lado izquierdo, no dolorosa. El resto del examen físico trascurrió sin otras alteraciones. La impresión diagnóstica inicial fue de teratoma abdominopélvico sustentada en la ecografía transvaginal en la que los ovarios se observaron normales, con una masa de ecogenicidad mixta de 50 x 40 x 46 mm, con áreas ecolúcidas y ecogénicas de intensidad variable hacia la fosa iliaca izquierda superior, sin contacto con el ovario. El ligamento redondo se seccionó a ambos lados de la masa y se extrajo sin complicaciones; el reporte histopatológico fue de: teratoma quístico maduro. CONCLUSIONES: El ligamento redondo es una localización infrecuente de los quistes dermoides que debe considerarse en los diagnósticos diferenciales de las masas pélvicas; es susceptible de tratamiento quirúrgico por vía laparoscópica.

Abstract BACKGROUND: Teratoma is an almost always benign tumor, with a wide variability in its location; its location in the round ligament is extremely rare. CLINICAL CASE: 30-year-old patient, with a history of a full-term pregnancy. On routine ultrasound examination, a 46 x 35 mm left paraovarian cystic lesion was reported, with no solid, fatty component or calcifications. In the gynecological examination a mass was palpated above the uterus, oriented to the left side, non-painful. The rest of the physical examination passed without other alterations. The initial diagnostic impression was of abdomino-pelvic teratoma supported by transvaginal ultrasound in which the ovaries were normal, with a mass of mixed echogenicity of 50 x 40 x 46 mm, with echolucent and echogenic areas of variable intensity towards the left superior iliac fossa, without contact with the ovary. The round ligament was sectioned on both sides of the mass and removed without complications; the histopathologic report was: mature cystic teratoma. CONCLUSIONS: The round ligament is an infrequent location of dermoid cysts that should be considered in the differential diagnoses of pelvic masses; it is amenable to surgical treatment laparoscopically.

Percepción de brechas y oportunidades en eSalud de estudiantes de último año de Medicina en Colombia

Introducción: En los últimos años la explosión de dispositivos con acceso a internet en el mundo ha presentado una oportunidad para el desarrollo de intervenciones en salud. Métodos: Se realizó un estudio observacional transversal de tipo descriptivo; se clasificaron las propuestas de innovación presentadas por estudiantes de último año de medicina como trabajo final de un curso de eSalud. Los proyectos se clasificaron en tres dimensiones: grupo poblacional, problema de salud a resolver y tipo de intervención de salud digital. Resultados: Se analizaron 86 proyectos entre los años 2017 y 2020. El 80,2 % se orienta a la población general, seguidos por la gestante (10,4 %), la infantil (8,14 %) y la geriátrica (1,2 %). El 36 % de los proyectos no mencionaban una condición particular de salud; el 12,8 % se dedicó a la salud sexual y reproductiva; el 10,4 % a las enfermedades cardiovasculares; el 9,3 % a la salud mental y el 4,65 % a aspectos de crecimiento y desarrollo. El 59,3 % de los proyectos se dirigía a apoyar las actividades del prestador de servicios de salud; el 34,9 % estaba orientado hacia las necesidades de los usuarios de los sistemas de salud y el 5,9 % se enfocó en los servicios de datos. Conclusiones: La percepción colectiva de los estudiantes refleja la oportunidad de fortalecer la atención primaria en salud mediante el uso de las tecnologías de la información y las comunicaciones, con énfasis en las poblaciones vulnerables. Los estudiantes empiezan a identificar los servicios de datos como oportunidad de intervención.

Introduction: In recent years, the explosion of devices with Internet access in the world has presented an opportunity for the development of health interventions. Methods: A descriptive cross-sectional observational study was carried out. Innovation proposals submitted by last-year medical students were classified as the final project of an eHealth course. The projects were classified into three dimensions: population group, health problem to be solved, and type of digital health intervention. Results: Eighty-six projects were analyzed from 2017 to 2020. 80.2% were aimed at the general population, followed by pregnant women (10.4%), children (8.14%) and geriatrics (1, 2 %). 36% of the projects did not mention a particular health condition; 12.8% was dedicated to sexual and reproductive health; 10.4% to cardiovascular diseases; 9.3% to mental health and 4.65% to aspects of growth and development. 59.3% of the projects were aimed at supporting the activities of the health service provider; 34.9% were oriented towards the needs of users of health systems and 5.9% focused on data services. Conclusions: The collective perception of the students reflects the opportunity to strengthen primary health care through the use of information and communication technologies, with emphasis on vulnerable populations. Students begin to identify data services as an opportunity for intervention.

Brazilian Society of Otology task force - Vestibular Schwannoma - evaluation and treatment

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Constrictive Pericarditis and Cardiac Tamponade Due to Tuberculosis as Presentation of Human Immunodeficiency Virus/Syndrome of Acquired Immunodeficiency: Case Report / Pericarditis constrictiva y taponamiento cardíaco por tuberculosis como presentación de virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida: presentación de caso / Pericardite constritiva e tamponamento cardíaco devido à tuberculose com uma apre-sentação do vírus da imunodeficiência adquirida: relato de cas

We report a case of constrictive pericarditis due to extrapulmonary tuberculosis associated with Human Immuno-deficiency Virus, complicated by cardiac tamponade that required surgical intervention in a drug user patient. The importance of early diagnosis and management is widely highlighted

El artículo presenta un caso de pericarditis constrictiva secundaria a tuberculosis extrapulmonar en un paciente con prueba positiva para virus de inmunodeficiencia humana (VIH) consumidor de sustancias psicoactivas, quien durante la hospitalización desarrolló un taponamiento cardíaco con requerimiento de intervención quirúrgica. Se plantea la discusión de la importancia de cada una de las pruebas solicitadas y el manejo adecuado en pacientes con dichas patologías

O artigo apresenta um caso de pericardite constritiva secundária à tuberculose extrapulmonar em paciente com teste positiva para vírus da imunodeficiência humana (HIV) e usuário de substâncias psicoativas que, durante a internação, desenvolveu tamponamento cardíaco com necessidade de intervenção cirúrgica. Discute-se a importância de cada um dos exames solicitados e o manejo ade-quado de pacientes com essas patologias

La ecografía de glándulas salivales en el diagnóstico del síndrome de Sjögren / Ultrasound of the salivary glands in the diagnosis of Sjögren´s syndrome

Objetivo: describir los hallazgos ecográficos en las glándulas salivares para el diagnóstico del síndrome de Sjögren primario. Metodología: se realizó una revisión narrativa de la literatura, con búsqueda en bases de datos seleccionando los principales artículos de revisión e investigaciones originales en español e inglés publicados en los últimos 20 años. Resultados: los hallazgos confirman el valor diagnóstico de la ecografía como estudio no invasivo de las glándulas salivares. Conclusión: la ecografía de glándulas salivares es un método útil y confiable para el diagnóstico del síndrome de Sjögren.

Objective: to describe salivary glands ultrasonography findings for the diagnosis of primary Sjögren ́s syndrome. Methodology: a narrative review of the literature by a database search selecting the main original review and research articles published in the last 20 years in Spanish and English. Results: findings confirm ultrasonography diagnostic value as a non-invasive method for salivary glands evaluation. Conclusion: sonographic evaluation of the salivary glands is a useful and reliable method for diagnosing Sjögren ́s syndrome.