Tumores Neuroendocrinos: un desafío transversal / Update on neuroendocrine tumors

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

Problemas éticos en la asignación de recursos escasos y cuidado intensivo en la atención de la pandemia por SARS-CoV-2 Una reflexión desde los principios, criterios, derechos y deberes / Ethical problems in the assignment of scarce resources and intensive care in SARS-CoV-2 pandemic healthcare Thoughts based on principles, criteria, rights and responsibilities

Resumen Este documento tiene como finalidad identificar algunos problemas éticos de los procesos de atención en el contexto de la pandemia por SARS-CoV-2 en Colombia, y proponer un conjunto de principios y criterios éticos que permitan a las instituciones y los trabajadores de la salud la toma de decisiones éticamente sustentables y jurídicamente factibles, con un especial enfoque en la protección del núcleo de los derechos fundamentales de pacientes y trabajadores, en un contexto extraordinario caracterizado por la inequidad estructural y la discrepancia entre la oferta y la demanda de bienes, recursos y servicios de salud, con el objetivo de mitigar el estrés moral, maximizar los beneficios derivados de la utilización de los recursos escasos y modular los riesgos éticos y jurídicos asociados.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1952).

Abstract The purpose of this document is to identify some ethical problems in healthcare processes within the context of the SARS-CoV-2 pandemic in Colombia, and propose a collection of ethical principles and criteria which will allow healthcare institutions and workers to make ethically supported and legally feasible decisions. These decisions should especially focus on protecting the core of the fundamental rights of patients and workers, in an extraordinary context characterized by structural inequity and a discrepancy between the supply and demand of healthcare goods, resources and services. Ultimately, this will mitigate moral stress, maximize the benefits derived from the use of scarce resources, and modulate the associated ethical and legal risks.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1952).

Incidencia de infección y trombosis asociadas a catéter central de inserción periférica (PICC) colocado por Radiología Intervencionista / Incidence of infection and thrombosis associated with peripheral insertion central catheter (PICC) placed by Interventional Radiology / Incidência de infecção e trombose associada a cateteres centrais de inserção periférica (linhas PICC) implantados pelo Serviço de Radiologia Intervencionista

Resumen: Objetivo general: Determinar la incidencia de la trombosis venosa (TV) e infección asociada con el catéter central de inserción periférica (PICC). Material y métodos: Se realizó un estudio retrospectivo, replicativo y descriptivo, cuya duración fue de 38 meses. Los catéteres centrales de inserción periférica se colocaron por el Servicio de Radiología Intervencionista con la misma técnica en las extremidades superiores. Se guardó una imagen del procedimiento con el nombre y diámetro de la vena usada. En el estudio se incluyó a partir del primer catéter PICC colocado en marzo de 2015 hasta el último en abril de 2018. Se registraron las trombosis venosas demostradas por ultrasonido Doppler, la duración del catéter y las bacteriemias relacionadas con el PICC (BRC-PICC). Resultados: Se colocaron 448 PICC y, de éstos, se excluyeron 78. Los 370 catéteres restantes sumaron 3,363 días-catéter. El 99.45% de los procedimientos resultaron exitosos. La incidencia de trombosis encontrada fue de 0.016% (n = 6) y la de infección de 0.03% (n = 12). El vaso más frecuentemente utilizado fue la vena basílica derecha. Conclusiones: La incidencia tanto de trombosis como de infección se mantiene por debajo de las reportadas en la literatura. Las venas mayores a 3.8 mm de diámetro tienen una probabilidad muy baja de presentar trombosis venosa.

Abstract: Objective: To determine the incidence of venous thrombosis (VT) and infection associated with PICC lines. Material and methods: A retrospective, replicative and descriptive study was conducted over 38 months. The PICC line was inserted in the upper extremities by the Interventional Radiology Service with the same technique. An image of the procedure with the name and diameter of the selected vein was saved. Venous thrombosis, demonstrated by Doppler ultrasound, the duration of the catheter and bacteremia related to the PICC line (BRC-PICC) were recorded. Results: 448 PICCs were placed and 78 were excluded. The remaining 370 catheters added 3,363 catheter days. 99.45% of the procedures were technically successful. The incidence of thrombosis was 0.016% (n = 6) and that of infection 0.03% (n = 12). The most frequently selected vessel was the right basilic vein. Conclusions: The incidence of thrombosis and infection were below the reported in the literature. Veins greater than 3.8 mm have a very low probability of having TV.

Resumo: Objetivo: Determinar a incidência de trombose venosa (TV) e infecção associada ao PICC. Material e métodos: Foi realizado um estudo retrospectivo, replicativo e descritivo, durante 38 meses. Os cateteres PICC foram colocados nas extremidades superiores pelo serviço de Radiologia Intervencionista com a mesma técnica. Guardou-se uma imagem do procedimento com o nome e o diâmetro da veia utilizada. Incluíu-se desde o primeiro cateter PICC colocado em março de 2015 até abril de 2018. Registraram-se as tromboses venosas por ultrassom Doppler, duração do cateter e bacteremias relacionadas ao PICC (BRC-PICC). Resultados: Colocaram-se 448 PICC e foram excluídos 78. Os 370 cateteres restantes somaram 3363 dias de cateter. 99.45% dos procedimentos foram bem sucedidos. A incidência de trombose encontrada foi de 0.016% (n = 6) e a de infecção de 0.03% (n = 12). O vaso mais utilizado foi a veia basílica direita. Conclusões: A incidência de trombose e infecção permanece abaixo da relatada na literatura. Veias com diâmetro superior a 3.8 mm têm uma probabilidade muito baixa de apresentar trombose venosa.

Relação entre índice de massa corporal e a funcionalidade/incapacidade de mulheres obesas / Relationship between body mass index and the functionality/disability of obese women

O objetivo do estudo foi avaliar a relação entre o Índice de Massa Corporal (IMC) de mulheres com obesidade tipo I e II com os domínios "Funções do Corpo" e "Atividades e Participação", que compõe o core set resumido da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) desenvolvido para obesidade. Participaram do estudo 72 mulheres, com idades entre 20 e 40 anos. O IMC foi determinado e, em seguida, utilizou-se o core set. Os resultados demonstram que o IMC não se relacionou com o escore de "Funções do Corpo" independentemente do tipo de obesidade, contudo, em mulheres obesas do tipo II, o IMC se correlacionou significativamente e positivamente com o escore de "Atividade e Participação" (r = 0,51; p = 0,002). A análise intergrupos demonstrou diferença significativa entre as obesas do tipo I (1,75 ± 0,23 pontos) e II (3,00 ± 0,23 pontos) no que se refere ao escore de "Atividades e Participação" (p = 0,013). Os achados demonstram que o grau de obesidade está relacionado com maiores índices de limitação/restrição funcional, o que pode direcionar a tomada de decisão clínica no que tange ações de prevenção, promoção e recuperação da saúde. (AU)

The objective of the study was to evaluate the relationship between the Body Mass Index (BMI) of women with type I and II obesity with the "Functions of the Body" and "Activities and Participation" domains, which compose the core set summarized from the International Classification of Functioning, Disability and Health (CIF) developed for obesity. 72 women, aged between 20 and 40, participated in the study. The BMI was determined and then the core set was used. The results showed that BMI was not related to the "Body Functions" score regardless of the obesity type; however, in type II obese women, the BMI correlated significantly and positively with the "Activity and Participation" (r = 0.51, p = 0.002). The intergroup analysis showed a significant difference between type I (1.75 ± 0.23 points) and II (3.00 ± 0.23 points) with respect to the "Activities and Participation" score (p = 0.013 ). The findings show that the degree of obesity is related to higher functional limitation/restriction indexes, which may lead to clinical decisionmaking regarding prevention, promotion and recovery of health. (AU)

Prevalence of hypoalbuminemia in outpatients with HIV/AIDS

Abstract INTRODUCTION: Hypoalbuminemia may predict progression of disease and mortality in patients with human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome (AIDS). This study was conducted to investigate the risk factors associated with hypoalbuminemia in outpatients with HIV/AIDS. METHODS: A cross-sectional study was performed in 196 outpatients with HIV/AIDS. RESULTS: The prevalence of hypoalbuminemia was 11.7%. The only risk factor associated with hypoalbuminemia was current antiretroviral therapy (no exposure: odds ratio=3.46, 95% confidence interval=1.20-10.02). CONCLUSIONS: The monitoring of plasma albumin is key to determine when antiretroviral therapy should be initiated in individuals not exposed to antiretroviral medicines.

Experiencia inicial en seguridad, tolerancia y adherencia al uso de docetaxel en pacientes con cáncer de próstata castración sensibles en un centro oncológico nacional / Initial experience in safety, tolerance and adherence to the use of docetaxel in patients with sensitive castration prostate cancer in a national cancer center

INTRODUCCIÓN: El cáncer de próstata (PC) es una enfermedad de alta incidencia y prevalencia (90/100.00 habitantes) y constituye la segunda causa por muerte oncológica en hombres, fenómeno que acontece en su fase metastásica (mPC). El tratamiento estándar en esta etapa corresponde a la terapia de deprivación androgénica (TDA) que produce una respuesta oncológica favorable en términos de descenso del PSA y estabilización y/o regresión de las metástasis. Ésta primera etapa (castración sensible) dura en promedio 2 a 3 años, tras lo cual ocurre una independización tumoral del estímulo androgénico, fenómeno conocido como castración-resistencia (mCRPC). En esta etapa la quimioterapia (QMT) con docetaxel prolonga la sobrevida aproximadamente 4 meses, lo cual en conjunto con otros tratamientos de segunda línea (abiraterona, enzalutamida, etc.) logra alcanzar una sobrevida media desde el diagnostico de mCRPC de 24 meses. Diversos estudios (CHAARTED y STAMPEDE) han demostrado que el inicio de docetaxel junto con TDA en pacientes con mPC castración-sensible (mCSPC) prolongan sobrevida global hasta 17 meses, especialmente si hay alto volumen de enfermedad. El objetivo del estudio es describir las características clínicas, la respuesta oncológica inicial y el perfil de efectos adversos de pacientes con mCSPC sometidos a docetaxel. MATERIALES Y MÉTODOS: Estudio retrospectivo descriptivo entre mayo 2014 a Julio 2017. Se incluyeron pacientes ng/ml (rango 10,8 - 5550) y mediana de seguimiento 6 meses (rango 3 ­ 20). Catorce pacientes tenían Gleason > 8, 18 eran M+ de los cuales 9 eran viscerales. Solo uno recibió tratamiento local previo. La mediana de inicio de QMT fue 3,1 (0 ­ 6,1) meses post inicio TDA.Dieciséis pacientes completaron docetaxel y 4 siguen en curso. No hubo suspensión de QMT por efectos adversos. Los más frecuentes fueron diarrea (8/20), neuropatía (5/20) y vómitos (2/20). La mayoría fue grado 1 y solo tres presentaron complicaciones grado 3 (diarrea, leucopenia y trombocitopenia). No hubo complicaciones grado 4 -5. Diez pacientes alcanzaron un antígeno < 2 ng/ml a las 12 semanas post tratamiento y 7 presentaron recidiva bioquímica durante el seguimiento. Uno tuvo respuesta imagenológica completa, 10 respuesta parcial, 7 estabilidad y 2 mostraron progresión. CONCLUSIONES: El uso de Docetaxel en mCSPC es seguro, presenta escasos efectos adversos (la mayoría de intensidad leve) que no motivan suspensión. El tratamiento con docetaxel exhibe una respuesta prometedora en términos de control de PSA, sin embargo se requiere mayor seguimiento de esta cohorte para evaluar impacto en sobrevida. con mCSPC con enfermedad de alto volumen (metástasis óseas extra-axiales, viscerales o Gleason 9-10) y ECOG 0-1. Los pacientes recibieron TDA y seis ciclos de Docetaxel. Se registraron datos demográficos, clínicos, histopatológicos, PSA, imagenológicos (RECIST V1.1) y toxicidad (NCI CAE 4.0) RESULTADOS: Se incluyeron 20 pacientes, mediana de edad 63 años (rango 49 ­ 75). Mediana PSA de ingreso 267,5 ng/ml (rango 10,8 - 5550) y mediana de seguimiento 6 meses (rango 3 ­ 20). Catorce pacientes tenían Gleason > 8, 18 eran M+ de los cuales 9 eran viscerales. Solo uno recibió tratamiento local previo. La mediana de inicio de QMT fue 3,1 (0 ­ 6,1) meses post inicio TDA.Dieciséis pacientes completaron docetaxel y 4 siguen en curso. No hubo suspensión de QMT por efectos adversos. Los más frecuentes fueron diarrea (8/20), neuropatía (5/20) y vómitos (2/20). La mayoría fue grado 1 y solo tres presentaron complicaciones grado 3 (diarrea, leucopenia y trombocitopenia). No hubo complicaciones grado 4 -5. Diez pacientes alcanzaron un antígeno < 2 ng/ml a las 12 semanas post tratamiento y 7 presentaron recidiva bioquímica durante el seguimiento. Uno tuvo respuesta imagenológica completa, 10 respuesta parcial, 7 estabilidad y 2 mostraron progresión. CONCLUSIONES: El uso de Docetaxel en mCSPC es seguro, presenta escasos efectos adversos (la mayoría de intensidad leve) que no motivan suspensión. El tratamiento con docetaxel exhibe una respuesta prometedora en términos de control de PSA, sin embargo se requiere mayor seguimiento de esta cohorte para evaluar impacto en sobrevida.(AU)

INTRODUCTION: Prostate cancer is a disease with high incidence and prevalence (90/100.000 habitants) and the second cause of cancer related death in men. Standard treatment in this setting is androgen-deprivation therapy (TDA), which causes decrease in PSA levels and stabilization or regression of metastatic lesions. Responses in castration sensitive phase last in average 3 years, after which tumor is described to become independent from the androgenic stimuli, reaching a castration-resistance (mCRPC) state. At this point chemotherapy with docetaxel as well as second line treatments (abiraterone, enzalutamide, among others)have shown to improve survival in 4 months with mean survival from diagnosis of mCRPC of 24 months. Studies including CHAARTED and STAMPEDE have demonstrated that early treatment with docetaxel with ADT in patients with mCSPC prolongs overall survival, especially if high volume disease exists. This study describes the clinical characteristics, initial oncologic response and side effects profile of mCSPC treated with Docetaxel plus ADT. MATERIALS AND METHODS: Descriptive Retrospective study from May 2014 to July 2017. mCSPC patients with high volume disease (extra axial bone metastasis, visceral metastasis or Gleason 9-10) and ECOG 0-1 were included. Patients received ADT and 6 cycles of Docetaxel. Demographic, clinical and histopathological characteristicswere registered, together with PSA, radiologic data (RECIST V1.1) and toxicity (NCI CAE 4.0). RESULTS: 20 patients were included, median age 63 years (49-75 range). Median initial PSA 267,5 ng/ml (10,8-5550 range), and median follow up 6 months (3-20 range). Fourteen patients had Gleason > 8, 18presented bone metastasis and 9/14 viscerametastasis. Only 1 patient received previous local treatment. Median initialtime to initiation of Docetaxel post ADT was 3,1 (0-6,1) months.Sixteen patients completed docetaxel and 4 are still receiving treatment. There was no chemotherapy suspension due side effects. Most frequent side effects were diarrhea (8/20), neuropathy (5/20) and vomiting (2/20). Most were grade 1 and three patients presented grade 3 side effects (diarrhea, leukopenia and thrombocytopenia). No grade 4-5 side effects were reported.Ten patients reached PSA< 2 ng/m after 12 weeks of treatment, and 7 had biochemical relapse during follow up. One had complete radiologic response, 10 partial response, 7 remained stable and 2 showed progression of disease. CONCLUSION: The use of docetaxel in mCSPC isassociated to few side effects and none requiredsuspension of treatment. Treatment with Docetaxel exhibits promising results in terms of decrease in PSA, however longer follow up and greater number of patients are required to report benefits in overall survival.(AU)

Kinosternon scorpioides scorpioides (TESTUDINES: KINOSTERNIDAE): NUEVO REPORTE EN EL NORORIENTE DE COLOMBIA / Kinosternon scorpioides scorpioides (Testudines: Kinosternidae): A New Record from Northeastern Colombia

RESUMEN Presentamos un nuevo reporte de la tortuga escorpión Kinosternon scorpioides scorpioides para el departamento de Norte de Santander, Colombia. Este espécimen fue colectado en el bosque seco tropical del departamento, el cual es uno de los ecosistemas más amenazados y menos protegidos del país; esto agravado por problemas locales de contaminación y de transformación del uso del suelo, motivos por los que la presencia y conservación de K. s. scorpioides se encuentra en riesgo.

ABSTRACT We present a new record of the Scorpion Turtle Kinosternon scorpioides scorpioides for the department of Norte de Santander, Colombia. This specimen was collected in the tropical dry forest of the department, which is one of the most threatened and least protected ecosystems in the country; this exacerbated by local problems related with pollution and land-use transformation, threatening the presence and conservation of K. s. scorpioides.

Desempenho e indicadores cardiorrespiratórios em crianças no teste progressivo máximo / Performance and cardiorespiratory indicators in children in the maximum progressive test / Rendimiento e indicadores cardiorrespiratorios en niños en prueba incremental máxima

RESUMO Introdução: As crianças estão sempre envolvidas em atividades físicas e em esportes coletivos. Assim, os estudos que mesclam o desempenho físico e a capacidade cardiorrespiratória são necessários para incentivar e aplicar ações promotoras de saúde. Objetivo: Avaliar a resposta do desempenho físico e dos indicadores cardiorrespiratórios na interrupção espontânea do teste progressivo máximo em crianças. Método: Estudo prospectivo, analítico, observacional e transversal. Participaram 106 crianças com média de idade de 10,2 ± 1,1. O peso e altura foram obtidos para determinar o índice de massa corporal, e a capacidade cardiorrespiratória foi avaliada por meio do teste progressivo máximo de Léger. As variáveis observadas foram: frequência cardíaca, frequência respiratória, pico de fluxo expiratório forçado, volume de oxigênio máximo e força da musculatura abdominal. As crianças foram divididas conforme o desempenho no teste progressivo máximo, grupo de até 280 metros e grupo acima de 280 metros. Resultado: O valor médio do índice de massa corporal foi de 17,8 kg/m2 e o volume de oxigênio máximo de 40,5 mlO2/kg-1.min-1. O grupo que atingiu maior distância no teste progressivo máximo obteve menor índice de massa corporal (p = 0,002), maior velocidade (p = 0,000), maior tempo no esforço físico (p = 0,000), maior volume de oxigênio máximo (p = 0,000), maior força muscular abdominal (p = 0,007). As variáveis frequência cardíaca, respiratória e o peak flow tinham valores esperados para a idade, sem diferença entre os grupos. O grupo que atingiu maior distância teve correlação com a velocidade (r = 0,950, p < 0,000) e com volume de oxigênio (r = 0,740, p < 0,000). Já o grupo de menor distância apresentou maior correlação com o índice de massa corporal (r = -0,475, p = 0,000) e frequência respiratória (r = 0,585, p < 0,674). Conclusão: As crianças com menor massa corporal apresentaram melhor desempenho no teste progressivo máximo, e as meninas destacaram-se pelo maior tempo de esforço físico sem aumento do consumo de oxigênio máximo.

ABSTRACT Introduction: Children are always involved in physical activities and team sports. Thus, studies that combine phy-sical performance and cardiorespiratory fitness are necessary to encourage and implement health promotion actions. Objective: To evaluate the response of physical performance and cardiorespiratory indicators in the spontaneous inter-ruption of a maximum progressive test in children. Method: Prospective, analytical, observational and cross-sectional study. One hundred and six children with a mean age of 10.2 ± 1.1 years participated in the study. Weight and height were obtained to determine the body mass index and the cardiorespiratory fitness was evaluated by the maximum progressive Léger test. The observed variables were heart rate, respiratory rate, peak forced expiratory flow, maximum oxygen volume, and abdominal muscle strength. The children were divided according to their performance in the maximum progressive test, a group achieving up to 280 meters and a group achieving over 280 meters. Result: The mean value of body mass index was 17.8 kg/m2 and the maximum oxygen volume was 40.5 mlO2/kg-1.min-1. The group that reached the greater distance in the maximum progressive test had a lower body mass index (p=0.002), a higher speed (p=0.000), a longer time in the physical effort (p=0.000), higher maximum oxygen volume (p=0.000), and a greater abdominal muscle strength (p=0.007). The variables heart rate, respiratory rate and peak flow had values expected for age with no difference between groups. The group that reached the greater distance had a correlation with speed (r=0.950, p<0.000) and with oxygen volume (r=0.740, p<0.000). In contrast, the shorter distance group had a higher correlation with body mass index (r=-0.475, p=0.000) and respiratory rate (r=0.585, p<0.674). Conclusion: Children with a lower body mass presented better performance in the maximum progressive test, and girls stood out for the greater time of physical effort without increasing the maximum oxygen uptake.

RESUMEN Introducción: Los niños siempre están involucrados en actividades físicas y en deportes de equipo. Por lo tan-to, se necesitan estudios que combinan el rendimiento físico y la capacidad cardiorrespiratoria para fomentar e implementar acciones que promueven la salud. Objetivo: Evaluar la respuesta del rendimiento físico e indicadores cardiorrespiratorios en la interrupción espontánea del test progresivo máximo en niños. Método: Estudio prospectivo, analítico, observacional y transversal. Participaron 106 niños, con edad promedio de 10,2 ± 1,1. El peso y la altura fueron obtenidos para determinar el índice de masa corporal y la capacidad cardiorrespiratoria fue evaluada por la prueba incremental máxima de Léger. Las variables observadas fueron: frecuencia cardiaca, frecuencia respiratoria, pico de flujo espiratorio forzado, volumen máximo de oxígeno y fuerza de los músculos abdominales. Los niños fueron divididos en función del rendimiento en la prueba incremental máxima, un grupo de hasta 280 metros y un grupo de más de 280 metros. Resultados: El índice de masa corporal promedio fue de 17,8 kg/m2 y el volumen máximo de oxígeno 40,5mlO2/kg-1.min-1. El grupo que alcanzó la mayor distancia en la prueba incremental máxima presentó menor índice de masa corporal (p = 0,002), mayor velocidad (p = 0,000), más tiempo en esfuerzo físico (p = 0,000), mayor volumen de oxígeno máximo (p=0,000), mayor fuerza muscular abdominal (p = 0,007. Las variables frecuen-cia cardiaca, respiratoria y el peak flow tenían los valores esperados para la edad, sin diferencia entre los grupos. El grupo que alcanzó mayor distancia presentó correlación con la velocidad (r = 0,950, p < 0,000) y con el volumen de oxígeno (r = 0,740, p < 0,000). Sin embargo, el grupo de distancia más corta presentó mayor correlación con el índice de masa corporal (r = -0,475, p = 0,000) y la frecuencia respiratoria (r = 0,585, p < 0,674). Conclusión: Los niños con menor masa corporal mostraron mejor rendimiento en la prueba incremental máxima, y las niñas se destacaron con mayor tiempo de esfuerzo físico sin aumento del consumo máximo de oxígeno.

Un caso de carcinoma de tiroides de células de Hürthle. Abordando la incertidumbre del papel del Yodo I-131 / A case of Hürthle Cell Thyroid Carcinoma. Dealing with the Uncertainty of the Role of Iodinel-131 / Um caso de carcinoma de tireoides de células de Hürthle. Abordando a incerteza do papel do Iodo I-131

Objetivo: el fin de este artículo es dar a conocer la experiencia del manejo multidisciplinario de un caso documentado de carcinoma de células de Hürthle en el que se encontró captación con I-131 y por lo tanto opción terapéutica con el mismo. Presentación de caso: se trata de una paciente en la sexta década de la vida, diagnosticada inicialmente con bocio difuso quien fue manejada con terapia de sustitución hormonal con análogos de tiroxina sin respuesta satisfactoria, por lo que se realizó biopsia tiroidea, cuyo resultado reportó neoplasia de células de Hürthle de comportamiento inespecífico. Se realizó tiroidectomía oncológica y linfadenectomía. Se realizó revisión de placas de patología y se llegó a un diagnóstico definitivo de carcinoma de Hürthle. Se llevó el caso a junta multidisciplinaria y se decide terapia con I-131 pero este proceso llevó a que la terapia se realizara de forma tardía; aun así se evidencia en el rastreo postratamiento, captación en adenopatía cervical. Finalmente, presentó recaída pulmonar 12 meses después. Este tipo de tumor es un desafío para los médicos tratantes por la incertidumbre en su historia natural, en su tratamiento y en la utilidad del I-131, esta última es muy debatida debido a su alta tendencia a la desdiferenciación y al bajo porcentaje de los mismos que presentan captación del radiofármaco. Es incierto si la paciente de este caso se hubiese podido beneficiar de una terapia ablativa con I-131 más temprana disminuyendo el riesgo de recaída luego de haberse documentado avidez tumoral por el mismo

Objetive: The objective is to present a case with successful I-131 uptake in a patient with Hürthle cell carcinoma. Case presentation: A 60 years old female patient with diagnosed goiter, that was treated with thyroid hormone analogues that didn't decreased the growth of the mass; due to that, it was biopsied. The report of the pathology reported a Hürthle cell neoplasm with indeterminate behavior, lately oncologic thyroidectomy and lymphadenectomy were performed, from which the pathology plates were revised showing a definitive diagnosis of Hurthle cell carcinoma. The case was reviewed in a medical board where I-131 therapy was suggested. In the postheraphy scan performed, there was evidence of I-131 uptake in the neck and in an adenopathy. Twelve months later, there was evidence of pulmonary relapse. Is an uncertainty to know if the patient in this case would have been able to benefit from an early ablative therapy with I-131 decreasing the risk of relapse after having documented tumor avidity for it. The Hürthle thyroid carcinoma is rare, and its natural history is still controversial because it's challenging diagnosis, treatment and monitoring. Because there is no definitive agree about his integral approach despite it has been considered differentiated thyroid cancer even therapy with I-131 is still debated

Objetivo: O fim deste artigo é dar a conhecer a experiência do manejo multidisciplinar de um caso documentado de carcinoma de células de Hürthle no qual encontrou-se captação com I-131 e pelo tanto opção terapêutica com o mesmo. Presentación de caso: Trata-se de uma paciente na sexta década da vida, diagnosticada inicialmente com bócio difuso que foi tratada com terapia de substituição hormonal com análogos de tiroxina sem resposta satisfatória, pelo que se realizou biopsia tireóidea, cujo resultado reportou neoplasia de células de Hürthle de comportamento inespecífico. Realizou-se tireoidectomia oncológica e linfadenectomia. Realizou-se revisão de placas de patologia e chegou-se a um diagnóstico definitivo de carcinoma de Hürthle. Levouse o caso à junta multidisciplinar e decide-se terapia com I-131 mas este processo levou a que a terapia se realizara de forma tardia; ainda assim evidencia-se no rastreamento pós-tratamento captação em adenopatia cervical. Finalmente, apresentou recaída pulmonar 12 meses depois. Este tipo de tumor pe um desafio para os médicos tratantes pela incerteza na sua história natural, no seu tratamento e na utilidade do I-131, esta útlima é muito debatida devido à sua alta tendência à desdiferenciação e à baixa percentagem dos mesmos que apesentam captação do radiofármaco. É incerto se a paciente deste caso se tivesse conseguido beneficiar de uma terapia ablativa com I-131 mais temporã diminuindo o risco de recaída após ter-se documentado avidez tumoral pelo mesmo

Terapia con [ 177 Lu - Dota0 - Tyr 3 ]-Octreotate ( 177 Lu-Dotatate) en pacientes con tumores avanzados de origen neuroendocrino: experiencia inicial y resultados preliminares / Therapy with [ 177 Lu - Dota0 - Tyr 3 ]-Octreotate ( 177 Lu-Dotatate) in Patients with Advanced Neuroendocrine Tumors: Initial Experience and Preliminary Results / Terapia com [ 177 Lu - Dota0 - Tyr 3 ]-Octreotate ( 177 Lu-Dotatate) em Pacientes com Tumores Avançados de Origem Neuroendócrino: Experiência Inicial e Resultados Preliminares

Resumen Objetivo: Mostrar la experiencia inicial y los resultados preliminares de la terapia con [177Lu -Dota0 - Tyr3] - Octreotate (177Lu-Dotatate) en pacientes tratados en la Fundación Cardioinfantil - Instituto de Cardiología (FCI-IC) debido a que la experiencia derivada de esta práctica en países latinoamericanos es poco conocida. Materiales y métodos: Se realizó un análisis descriptivo y retrospectivo en pacientes a los que se les realizó terapia con 177Lu-Dotatate con al menos una dosis y un año de seguimiento. Se incluyeron 8 pacientes (4 mujeres y 4 hombres) de edad media: 57 años (50-63). Se administraron 24 dosis en total, 3 dosis en promedio por paciente, 187 GBq totales y 23,5 GBq dosis/paciente. Se valoró la respuesta al tratamiento y la presencia de efectos adversos. Resultados: El tiempo medio de seguimiento fue de 46 meses (26-72 meses). 5/8 pacientes tenían diagnóstico de tumores neuroendocrinos (TNE) de origen pancreático, 2/8 de origen gástrico y 1/8 de yeyuno. 7/8 pacientes tenían compromiso metastásico; 1/8, a pesar de no tener afectación metastásica, fue considerado irresecable. 7/8 pacientes presentaron síntomas posterapia leves y 1/8 eventos adversos serios. 2/8 pacientes tuvieron respuesta parcial, 4/8 enfermedad estable y 2/8 respuesta completa. Sin embargo, al final del seguimiento un paciente que tuvo respuesta completa presentó recaída y otro, respuesta parcial con posterior progresión y muerte. Conclusiones: En la institución, la terapia con 177Lu-Dotatate ha sido segura y eficaz en pacientes con TNE como alternativa terapéutica con adecuados niveles de respuesta y control de la enfermedad con eventos adversos leves, esperables y eventos serios mínimos autolimitados.

Abstract Objective: To Show the initial experience and preliminary results of therapy with [177Lu -Dota0 - Tyr3] - Octreotate (177 Lu-Dotatate) in patients with neuroendocrine tumors (NET) treated in our institution, because the experience gained from this practice in Latin American countries is poorly known. Materials and methods: A descriptive and retrospective analysis in patients who have undergone therapy with 177 Lu-Dotatate with at least one dose and at least one year of follow-up was performed. 8 patients (4 women and 4 men) with a mean age of 57 years (50-63) were included. A total of 24 doses were given, an average of 3 doses per patient. A total of 187 GBq were administered, equivalent to 23.5 GBq / patient. Response to therapy and the presence of adverse short and long term effects were assessed. Results: The average follow-up time was 46 months (26-72 months). 5/8 patients were diagnosed with pancreatic net, 2/8 of gastric origin and 1/8 of small bowel origin. 7/8 patients had metastatic involvement and 1/8 patient despite not having metastasis was considered unresectable. 6/8 patients had mild post-therapy symptoms and 1/8 serious adverse events. 2/8 patients had partial response, 4/8 stable disease and 2/8 had a complete response. At the end of follow-up, however, one patient who had a complete response presented with recurrence and one with partial response showed progression and death. Conclusions: In our experience, therapy with 177 Lu-Dotatate was safe and effective in patients with net as an alternative therapy with appropriate levels of response and disease control and with mild expected adverse events and self-limiting minimum serious events.

Resumo Objetivo: Mostrar a experiência inicial e os resultados preliminares da terapia com [177Lu - Dota0 - Tyr3] -Octreotate (177Lu-Dotatate) em pacientes tratados na nossa instituição, devido a que a experiência derivada desta prática em países latino-americanos é pouco conhecida. Materiais e métodos: Se realizou uma análise descritiva e retrospectiva em pacientes aos que se lhes tem realizado terapia com 177Lu-Dotatate com ao menos uma dose e ao menos um ano de seguimento. Incluíram-se 8 pacientes, idade média de 57 anos (50-63). Administraram-se: 24 doses em total, 3 doses em média por paciente, 187 GBq totais administrados e 23.5 GBq doses/paciente. Valorou-se a resposta ao tratamento e a presença de efeitos adversos. Resultados: O tempo médio de seguimento foi de 45 meses (26-72 meses). 5/8 tinham diagnóstico de TNE de origem pancreática, 2/8 de origem gástrica e 1/8 de jejuno. 7/8 pacientes tinham compromisso metastático e 1/8 paciente apesar de não ter afetação metastática foi considerado irressecável. 6/8 pacientes apresentaram sintomas pós-terapia leves e 1/8 eventos adversos sérios. 2/8 pacientes tiveram resposta parcial, 4/4 doença estável e 2/8 resposta completa. No entanto, no final do seguimento um paciente que teve resposta completa apresentou recaída e outro resposta parcial com posterior progressão e morte. Conclusões: no nosso meio a terapia com 177Lu-Dotatate tem sido segura e eficaz em pacientes com TNE como alternativa terapêutica com adequados níveis de resposta e controle da doença com eventos adversos leves esperáveis e eventos sérios mínimos autolimitados.

Anthropometric Risk Factors for Metabolic Syndrome in HIV patients / Fatores de risco antropométricos para síndrome metabólica em pacientes com HIV

OBJECTIVE: Metabolic syndrome, which affects the general population in epidemic proportions, is associated with a set of cardiovascular disease risk factors. The aims of this cross-sectional study were to determine the prevalence and investigate the risk factors associated with metabolic syndrome in outpatients living with HIV/AIDS using anthropometric and clinical evaluations. METHOD: The study was carried out on 253 HIV infected outpatients. Metabolic syndrome was classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) and the International Diabetes Federation (IDF) criteria. Logistic regression was used to identify factors associated with the metabolic syndrome. RESULTS: The prevalence of metabolic syndrome varied from 19.4% to 26.4%, according to the criterion used. The factors associated with it in the two classifications used, when adjusted by sex and BMI, were age (≥ 40years) and subscapular skinfold (> 12 mm). In the final model, using the NCEP/ATPIII criterion the risk factors associated with metabolic syndrome were age ≥ 40 years (OR = 3.18; CI95% = 1.42; 7.14) and subscapular skinfold > 12 mm (OR = 2.85, CI95% = 1.13; 7.17). In the final model, using the IDF criterion the risk factors associated with metabolic syndrome were age (OR = 3.38, CI95% = 1.61; 7.10) and subscapular skinfold > 12 mm (OR = 4.37, CI95% = 1.84; 10.39). CONCLUSION: In clinical practice, the regular monitoring of subscapular skinfold can help in the identification of HIV infected individuals in risk of MS.

OBJETIVO: A síndrome metabólica afeta a população em geral em proporções epidêmicas e está associada a um conjunto de fatores de risco de doenças cardiovasculares. Os objetivos deste estudo transversal foram determinar a prevalência e investigar os fatores de risco associados à síndrome metabólica em pacientes ambulatoriais afetados por HIV/AIDS usando avaliações antropométricas e clínicas. MÉTODO: O estudo foi realizado em 253 pacientes ambulatoriais infectados pelo HIV. A síndrome metabólica foi classificada de acordo com o National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) e os critérios da International Diabetes Federation (IDF). A regressão logística foi utilizada para identificar os fatores associados à síndrome metabólica. RESULTADOS: A prevalência de síndrome metabólica variou entre 19,4% e 26,4%, de acordo com o critério utilizado. Os fatores associados nas duas classificações utilizadas, quando ajustados por sexo e IMC, foram: idade (≥ 40 anos) e subescapular (> 12 mm). No modelo final, utilizando o critério do NCEP/ATPIII os fatores de risco associados à síndrome metabólica foram idade ≥ 40 anos (OR = 3,18; IC95% = 1,42; 7,14) e dobra cutânea subescapular > 12 mm (OR = 2,85, IC95% = 1,13; 7,17). No modelo final, utilizando o critério IDF os fatores de risco associados à síndrome metabólica foram idade (OR = 3,38, IC95% = 1,61; 7,10) e dobra cutânea subescapular > 12 mm (OR = 4,37, IC95% = 1,84; 10,39). CONCLUSÃO: Na prática clínica, o acompanhamento regular da dobra cutânea subescapular pode ajudar na identificação de indivíduos infectados pelo HIV em risco de MS.

Avaliação da Dureza de Materiais Restauradores Diretos Submetidos a Diferentes Desafios Erosivos / Hardness Evaluation of Direct Restorative Materials Submitted to Different Erosive Challenges

Objetivo: Avaliar a dureza de materiais restauradores diretos submetidos a diferentes desafios erosivos in vitro. Material e método: Trata-se de um estudo experimental realizado com 12 amostras de cada material restaurador medindo 4 mm de diâmetro x 2 mm de espessura. As amostras de resinas (microparticulada e nanoparticulada) e dos cimentos de ionômero de vidro (convencional e modificado por resina) foram confeccionadas e a dureza de superfície foi determinada antes e após uma semana de desafio erosivo, sendo a troca dos meios realizada a cada 24 horas. A análise Estatística dos dados foi feita por ANOVA de 2 fatores. O Teste t pareado avaliou a comparação entre as durezas iniciais e finais. Os testes estatísticos foram realizados pelo Programa Minitab (versão 17) com o nível de significância fixado em 5%. Resultados e Conclusão: Os resultados mostram que cimento de ionômero de vidro convencional e resina nanoparticulada apresentaram maiores valores de perda de dureza. Quantos aos meios, a Coca-Cola ocasionou maior perda de dureza no Cimento de ionômero de vidro convencional e o Powerade provocou maior grau de erosão no Cimento de ionômero de vidro modificado por resina. Todos os materiais testados apresentaram redução na dureza da superfície como resultado do desafio erosivo em bebidas ácidas, sendo o cimento de ionômero de vidro convencional o material mais afetado.

Objective: To evaluate in vitro the hardness of restorative materials submitted to different erosion challenges. Material and method: This was an experimental study using 12 samples of each restorative material measuring 4 mm diameter x 2 mm thick. Resins samples (microparticulate and nanoparticulate) and glass ionomer cements (conventional and resin-modified) were prepared and the surface hardness was determined before and after a week of erosive challenge, with the media being changed at each 24 hours. The statistical analysis was performed by two-way-ANOVA. The paired t test evaluated the comparison between the initial and final hardness. Statistical tests were performed with Minitab Program (version 17) and the significance level was set at 5%. Results and Conclusion: Conventional glass ionomer cement and nanoparticulate resin had higher hardness loss values. Regarding the beverages, Coca-Cola caused higher hardness loss in the conventional glass ionomer cement and Powerade lead to a higher degree of erosion in the glass ionomer cement modified by resin. Conclusion: All materials tested showed reduction in surface hardness as a result of erosive challenge in acidic drinks. Conventional glass ionomer cement was the most affected material.

Beneficio de la quimioterapia adyuvante en pacientes con cáncer de colon: cohorte retrospectiva de un hospital clínico universitario / Benefit of adjuvant 5-fluorouracil based chemotherapy for colon cancer: a retrospective cohort study

Background: Multiple clinical trials have demonstrated the benefits of adjuvant 5-fluorouracil-based chemotherapy for patients with resectable colon cancer (CC), especially in stage III. Aim: To describe the clinical characteristics of a cohort of CC patients treated at a single university hospital in Chile since 2002, and to investigate if chemotherapy had an effect on survival rates. Material and Methods: Review of a tumor registry of the hospital. Medical records of patients with CC treated between 2002 and 2012 were reviewed. Death certificates from the National Identification Service were used to determine mortality. Overall survival was described using the Kaplan-Meier method. A multivariate Cox proportional hazard regression model was also used. Results: A total of 370 patients were treated during the study period (202 in stage II and 168 in stage III). Adjuvant chemotherapy was administered to 22 and 70% of patients in stage II and III respectively. The median follow-up period was 4.6 years. The 5-year survival rate for stage II patients was 79% and there was no benefit observed with adjuvant chemotherapy. For stage III patients, the 5-year survival rate was 81% for patients who received adjuvant chemotherapy, compared to 56% for those who did not receive chemotherapy (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.15-0.56). The benefit of chemotherapy was found to persist after adjustment for other prognostic variables (HR: 0.47; 95% CI: 0.23-0.94).Conclusions: Patients with colon cancer in stage III who received adjuvant chemotherapy had a better overall survival.

Colesterol HDL y troponina T ultrasensible como biomarcadores predictivos de fibrilación auricular postoperatoria / HDL cholesterol and high-sensitive troponin T as predictives biomarkers of atrial fibrillation after heart surgery

Introducción: La fibrilación auricular (FA), con una incidencia aproximada del 30%, es la arritmia más frecuente tras cirugía cardiaca. Se han asociado a la FA factores como la inflamación, la presencia de fibrosis cardiaca, el estrés y la apoptosis de cardiomiocitos. Objetivos: Consideramos que el remodelado auricular es un proceso preexistente en los pacientes con FA posquirúrgica. Analizamos los factores relacionados con la incidencia de FA en el postoperatorio de cirugía cardiaca. Métodos: Incluimos a pacientes consecutivos, estables hemodinámicamente y en ritmo sinusal, sometidos a cirugía cardiaca programada con circulación extracorpórea. Se valora la caída en FA posquirúrgica. Resultados: Se incluyeron un total de 100 pacientes sometidos a cirugía de revascularización coronaria (59) o sustitución valvular aórtica (41) por estenosis aórtica grave. La FA postoperatoria se produjo en 29 pacientes con predominio de la cirugía valvular respecto a la cirugía coronaria. Los factores predictivos de la aparición de FA postoperatoria en el análisis multivariable fueron el sexo masculino, la ausencia de terapia crónica con betabloqueadores, la perfusión de fibrinógeno intraoperatorio, valores bajos de colesterol HDL y valores elevados de troponina T ultrasensible en el preoperatorio. Conclusiones: El colesterol HDL y la troponina T ultrasensible pueden ser biomarcadores útiles para predecir la aparición de FA postoperatoria. La identificación precoz de estos pacientes nos permite adoptar medidas preventivas para minimizar sus efectos negativos.

Introduction: Atrial fibrillation (AF) has an incidence rate of approximately 30% and is the most frequent arrhythmia following heart surgery. Factors such as inflammation, the presence of heart fibrosis, stress and cardiomyocyte apoptosis, have all been associated with AF. Objectives: We believe that atrial remodelling is a pre-existent process in patients with post-surgical AF. We have analyzed the factors related to the incidence of atrial fibrillation in the period after heart surgery. Methods: We included consecutive, hemodynamically stable patients with a sinusal rhythm who were subjected to programmed heart surgery with extracorporeal circulation. An assessment was made of the fall in atrial fibrillation after surgery using prolonged electrocardiographic monitoring. Results: A total of 100 patients were included in the study and were subjected to either coronary revascularisation surgery (59) or aortic valve substitution due to severe aortic stenosis (41). Postoperative AF occurred in 29 patients who received predominantly more valve surgery than coronary surgery. The following factors were predictive of postoperative AF in the multivariate analysis: Male sex; beta-blocker therapy for chronic disease; the use of intraoperative; fibrinogen perfusion; low HDL cholesterol values; and high sensitive troponin T values, in the preoperative period. Conclusions: HDL cholesterol and high sensitive troponin T can be useful biomarkers to predict the occurrence of AF after surgery. The early identification of these patients who develop of FA allows us to take preventive measures to minimize the negative effects.

Avaliação nutricional de pacientes com câncer de mama atendidas no Serviço de Mastologia do Hospital das Clínicas, Belo Horizonte (MG), Brasil / Nutritional status of patients with breast cancer attended in the Mastology Service of Belo Horizonte's Hospital das Clínicas in the state of Minas Gerais, Brazil

O objetivo deste artigo é avaliar o perfil nutricional, a composição corporal e as características tumorais de 31 pacientes com câncer de mama atendidas pelo Serviço de Mastologia do Hospital das Clínicas da Universidade Federal de Minas Gerais. Os dados da dieta foram coletados usando-se o recordatório de 24 horas no momento pré-cirúrgico e analisados pelo Software de Nutrição DietWin Profissional 2008. A composição corporal foi avaliada por análise de impedância bioelétrica. A caracterização tumoral foi realizada através da avaliação dos dados obtidos no prontuário de cada paciente. A idade média foi de 50,75 ± 14,3 anos. Foi observado excesso de peso corporal em 58% das pacientes e circunferência da cintura maior que 80 cm em 64,5%. Consumo excessivo de alimentos pertencentes aos grupos dos óleos e dos açúcares foi verificado em 90,3% e 83,8%, respectivamente. A maioria das pacientes apresentou baixo consumo de cálcio e de vitaminas B6, B12 e A. O diagnóstico predominante foi de carcinoma ductal invasivo, de grau histológico tipo II em estadio II ou III. A prevalência do excesso de peso e a inadequação do consumo alimentar demonstram a necessidade de orientação e acompanhamento nutricional individualizado, visando melhorar o prognóstico e a qualidade de vida da paciente.

The scope of this article is to evaluate the nutritional status, body composition and tumor characteristics of 31 patients with breast cancer attended at the Mastology Service of Hospital das Clínicas of the Federal University of Minas Gerais. Dietary data were obtained from the 24-hour dietary recall in the pre-operative state and analyzed by the DietWin Professional 2008 Nutrition Software. Body composition was assessed by bioelectrical impedance analysis. The tumor characterization data were collected from medical records. The mean age of patients was 50.75 ± 14.34 years. Excess body weight was found in 58% and waist circumference greater than 80 cm in 64.5% of patients Excessive consumption of oils and sugars was observed in 90.3% and 83.8%, respectively. Most had low intakes of calcium and vitamins B6, B12 and A. The predominant diagnosis was type II histological grade invasive ductal carcinoma in stage II or III. The prevalence of overweight and inadequate dietary intake demonstrate the need for individualized nutritional guidance and monitoring to improve the prognosis and quality of the life of patients.

Tromboembolismo pulmonar masivo con respuesta exitosa a trombolisisfarmacológica: Caso clínico / Massive pulmonary thromboembolism treated successfully with streptokinase: Report of one case

Massive pulmonary thromboembolism has a high mortality. Early thrombolysis is the treatment of choice. We report a 79-year-old man admitted in shock. A chest angio-CAT scan showed a massive pulmonary thromboembolism. A transthoracic echocardiography showed a right cardiac dysfunction. Although the patient was in hemodynamic instability, he was subjected to thrombolysis with streptokinase, assisted with noradrenaline support and invasive mechanical ventilation. Parenteral anticoagulation was started thereafter. A second echocardiography, performed 72 hours later showed an improvement in right ventricular function. The patient had a nosocomial pneumonia that was treated. Noradrenalin and mechanical ventilation were discontinued nine and 15 days after thrombolysis. A new angio-CAT scan, 23 days after the procedure, was normal. The patient was discharged in good conditions 27 days after admission.

Prevalencia del trastorno de estrés post traumático en población en situación de desplazamiento en la localidad de Ciudad Bolívar Bogotá, Colombia 2007 / Prevalence of post traumatic stress disorder in displaced people in the town of Ciudad Bolivar Bogota, Colombia 2007

El fenómeno del desplazamiento humano se ha convertido en uno de los ejes de intervención en salud pública; sin embargo, en los estudios colombianos sobre la población desplazada por el conflicto armado, no se ha hecho énfasis en las repercusiones en la salud mental. El presente estudio tuvo como propósito caracterizar 110 personas en situación de desplazamiento en la localidad de Ciudad Bolívar (Bogotá, Colombia), susceptibles de manifestar cuadros de trastorno de estrés postraumático (TEPT). A través de análisis descriptivos y un modelo de regresión logística se estableció la prevalencia del TEPT. La edad de los desplazados evaluados osciló entre los 19 y 74 años, la media fue de 38.45 años, el DS de 13.44; y la varianza de 180.70. Se concluyó que la prevalencia del TEPT en la localidad es 97.27%, sin diferencias significativas en la presentación por género. El desplazamiento es causado en mayor proporción por hostigamiento de grupos guerrilleros; hay diferencias estadísticamente significativas en la presentación del cuadro respecto al estado laboral y la percepción de calidad de vida.

The phenomenon of human displacement has become one of the key public health interventions, but in studies on population Colombians displaced by armed conflict has not been an emphasis on the impact on mental health. This study aimed to characterize 110 people in situation of displacement in the village of Ciudad Bolívar (Bogotá, Colombia) likely to manifest PTSD boxes. Through descriptive analysis and a logistic regression model was established the prevalence of PTSD. The age of the displaced evaluated ranged between 19 and 74, Subjects averaged 38.45 years, SD 13.44, variance 180.70. It was concluded that the prevalence of PTSD in the town is 97.27%, without significant differences by gender in the presentation. The shift is caused by harassment in higher proportion of guerrilla groups; there are significant differences in the presentation of the table with respect to employment status and perceived quality of life.

Dermolipectomia higiênica em infecção por micobactéria não tuberculosa: relato de caso / Hygienic dermolipectomy in infeccion by non-tuberculous mycobacteria: case report

Introdução: A incidência de infecção por micobactéria não tuberculosa está aumentando em todo o mundo. No Brasil, já tivemos dois grandes surtos dessa infecção após cirurgias plásticas. Isso tem chamado a atenção de cirurgiões quanto ao diagnóstico e ao tratamento da micobacteriose. Fisiopatologia: As estações de tratamento de água são os reservatórios das micobactérias. As mesmas acabam por contaminar equipamentos médicos. Após o contato do paciente com o material, este desenvolve a infecção. Tratamento: É realizado por meio do uso de antibióticos. Às vezes, a ressecção das lesões acelera o tratamento. Relato do caso: Relatamos o caso de um paciente ainda obeso, com abdome em avental após perda ponderal acentuada, e com múltiplas lesões por micobactéria disseminadas por todo o abdome. A fonte de infecção foi uma colecistectomia convencional. Como forma de ressecar todas as lesões macroscópicas do abdome, optamos por realizar uma dermolipectomia higiênica após marcação do abdome em âncora. Conclusão: A melhor maneira de nossos pacientes não adquirirem esse tipo de infecção é assegurarmos a higiene adequada de nosso material cirúrgico.

Introduction: The incidence of non tuberculous mycobacterial disease is increasing worldwide. In Brazil, we had two big outbreaks of this bacterial infeccion after plastic surgeries. This has drawn the attention of surgeons to the diagnosis and treatment of mycobacteriosis. Physiopatologhy: Water supplies are now recognized as a reservoir for mycobacterias. These bacterias end up contaminating medical equipment. After the contact of the patients with the material, they develop the infeccion. Treatment: Mycobacterial lesions are primarily treated using antimicrobial agents. However, removal of the lesion may speed resolution. Case report: We reported a case of a patient still obese, with massive hanging pannus after important weigtht loss and multiple injuries by mycobacteria spread throughout the abdomen. The source of infection was a conventional cholecystectomy. As a way to resect all macroscopic lesions of the abdomen, we choose to perform a hygienic dermolipectomy after marking in anchor. Conclusion: The best way of our patients not to acquire this type of infection is through the appropriate hygiene of our surgical material.