The physiology of orgasmic headache

Orgasmic headache is a headache caused by sexual activity that emerges as sexual excitement increases (progressive at onset) or as an immediate and powerful headache following orgasm (thunderclap at onset) or combines these two characteristics. The idea that orgasmic headache (OGH) is caused by physiologically inappropriate responses is extremely simplistic. As a result, a complete analysis of the physiological mechanisms is provided here in order to comprehend the complex situation of OGH. The physiology of OGH was studied in humans utilizing peer-reviewed papers from Pubmed, Science direct, EBSCO, Scopus, Cochrane library, Sage Journals, and Google Scholar. Author, year of publication published between 2003 and 2020. OGH can regulate psychophysiological reactions, but it can also cause a rise in blood pressure, persistent pain, intracranial hemorrhage, and cerebral infarction. This review explains two physiological systems: the release of calcitonin gene-related peptide (CGRP), which induces the creation of less serotonin, resulting in an inflammatory response and discomfort. The release of epinephrine and nor-epinephrine can cause cerebral ischemia, which can lead to headaches in headache-prone patients. Fear of an orgasmic headache can lead to lower libido, leading to lower sex pleasure. As a result, the condition may deprive sex of its pleasure and turn it into a ‘headache’. We conduct a literature review to study the physiological processes of OGH in connection to its physiological maladaptive responses. A greater understanding of the physiological mechanisms underlying Orgasmic headache will allow practitioners to properly identify and counsel patients without attributing physiological maladaptive reactions to OGH.

LOGISTICS AND SUPPLY CHAIN MANAGEMENT: HUMAN RESOURCE CAPACITY AND TRAINING NEEDS ASSESSMENT OF PHARMACISTS IN NIGERIA

Objective: Logistics and supply chain management have received global attention since the early 1980s, but this concept is thought to still be unpopular in Nigeria as very little literature exists on it, especially in the pharmaceutical sector. This paper, therefore set out to investigate the human resource capacity and the needs assessment of pharmacists in Nigeria as regards logistics and supply chain management.Methods: This cross-sectional study was conducted among pharmacists in Nigeria. A total of 873 pharmacists participated in the study. A well-structured questionnaire was produced, validated, and administered to the registered pharmacists.Results: Out of the 873 retrieved questionnaires, 21 copies were not completely filled and were therefore discarded; hence the 852 completely filled questionnaires were taken as the number of participants in the study. The survey shows that out of the 51.76% pharmacists who have acquired trainings, 18.2% were exposed to supply chain management by virtue of their workplace, while 30.9% were self-trained through conferences and workshops. Also, 98.8% of the respondents were ready to be trained in this emerging field in Nigeria, with only 1.2% declining any interest in supply chain management training.Conclusion: These findings show that there is a low provision for proactive education on supply chain management for pharmacists. However, there is a promising opportunity to introduce such training as the majority of the respondents were receptive to such an innovation. This study may, therefore be useful for policymakers and health professionals to chart the path for the future to ensure adequate and proper delivery of medicines and other health commodities.

Changes in olfaction and taste in patients hospitalized for COVID-19 and their relationship to patient evolution during hospitalization

Abstract Objectives: During the COVID-19 pandemic, several cases of changes in olfaction and taste associated with the infection have been reported. Therefore, otolaryngologists are frequently the first medical professionals sought by patients. The aim of this study was to evaluate the frequency of olfaction and taste disorders in patients hospitalized with COVID-19, and their association with other clinical manifestations and patient evolution during hospitalization. Methods: 248 patients, admitted to three public hospitals in Belo Horizonte, Minas Gerais, Brazil, were prospectively included: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), Hospital Júlia Kubitschek (HJK) and Hospital Eduardo de Menezes (HEM), who, upon admission to hospital, presented with Severe Acute Respiratory Syndrome due to COVID-19. Clinical and laboratory variables and outcomes during hospitalization were prospectively collected from the electronic medical records. The collection of sociodemographic and symptomatology data during the acute phase was carried out prospectively in electronic medical records and confirmed with the patients at a subsequent outpatient visit. Results: The most frequently reported symptoms were dyspnea (77.4%), cough (69.8%) and fever (55.2%). During the acute phase of the disease, 95 (38.3%) and 87 (35.1%) patients reported taste and olfaction disorders, respectively. There was a lower prevalence of dysosmia among patients with previous comorbidities (p < 0.05). Both symptoms were associated with less need for intensive care admission (p = 0.001 for dysgeusia and p = 0.021 for dysosmia) and a negative correlation with length of hospital stay (dysosmia: r= −0.175, p < 0.05; dysgeusia: r = −0.29, p < 0.001) and length of stay in the ICU (dysosmia: r = −0.136, p < 0.05; dysgeusia: r = −0.215, p < 0.05). The absence of taste disorders was also associated with a greater need for mechanical ventilation (p < 0.001). Conclusion: Changes in taste and olfaction were reported by a large number of patients in the acute phase of COVID-19. In this study, both were markers of better clinical patient evolution. Level of evidence: 1B.

Chromosomic studies in Zephyranthes citrina baker (Amaryllidaceae), a polyploid ornamental / Estudios cromosómicos en Zephyranthes citrina baker (Amaryllidaceae), un poliploide ornamental

ABSTRACT Zephyranthes citrina is an ornamental American bulbous plant used as an ornamental garden crop for the aesthetic qualities of its yellow perigonium. The objective of this work was to characterize the species by classical chromosome staining and fluorochrome banding. A sporophytic chromosome number of 2n=8x=48 chromosomes was observed, being the karyotypic formula 20 m + 26 sm + 2 st. Satellites were detected in the short arm of metacentric chromosomes 8, 9, 11 and 12, which colocalized with constitutive heterochromatin CMA+/DAPI-/0 bands. The karyotype comprised chromosome pairs with terminal constitutive heterochromatin bands that included satellites and heteromorphic clusters indicating that it is an allooctoploid. These results will be used as a tool for monitoring genetic improvement, in interspecific crosses and its progenies and in biotechnological procedures by in vitro culture.

RESUMEN Zephyranhtes citrina es una planta bulbosa americana, ornamental, utilizada en jardines por las cualidades estéticas de su perigonio amarillo. El objetivo de este trabajo fue caracterizar citogenéticamente la especie con tinción clásica convencional y bandeo cromosómico. Se observó un número cromosómico esporofítico de 2n=8x=48, siendo la fórmula cariotípica 20 m + 26 sm + 2st. Se detectaron satélites en el brazo corto de los cromosomas metacéntricos 8, 9, 11 y 12, que co-localizaron con bandas de heterocromatina constitutiva CMA+/DAPI-. El cariotipo comprendió pares de cromosomas con bandas de heterocromatina constitutivas terminales que incluyeron satélites y grupos heteromórficos que indican que es un alooctoploide. Estos resultados serán usados como herramientas en el monitoreo del mejoramiento genético, en análisis de cruzamientos interespecíficos y progenies y en procedimientos biotecnológicos de cultivo in vitro.

Inequidades en la atención del cáncer de mama en Colombia: revisión sistemática / Disparities in breast cancer care in Colombia: systematic review / Inequidades na atenção do câncer de mama na Colômbia: revisão sistemática

Objetivo: determinar la existencia de inequidades de acceso al diagnóstico y tratamiento del cáncer de mama en mujeres de Colombia y describir los principales factores de riesgo asociados. Metodología: se realizó una búsqueda sistemática con los términos: "neoplasias de la mama" AND "inequidades de salud" OR "inequidades del estado de salud" OR "factores socioeconómicos" AND "Colombia", en las bases de datos Pubmed (Medline), Scielo, Cochrane, EBSCO, Ovid, Elsevier, Lilacs, Imbiomed, en español, inglés y portugués, publicados desde 1 de enero 2000 al 31 de octubre de 2019. Resultados: fueron seleccionadas 14 publicaciones. Se identificó que el estrato socioeconómico, el nivel educativo y el tipo de aseguramiento, en la mayoría de los estudios, se relacionan con las inequidades en cuanto a la enfermedad, con efectos variables sobre el riesgo de cáncer de seno e impacto sobre la detección temprana y el tratamiento. Estas variables influyen sobre la supervivencia total y sobre la libre de enfermedad. Conclusiones: se identifican inequidades en salud en las pacientes con cáncer de mama en Colombia. Los factores identificados son el tipo de aseguramiento, el estrato socioeconómico bajo y la escasa formación escolar, que implican retraso en el diagnóstico y empeoran la condición clínica y la calidad de vida de las pacientes.

Objective: To determine the existence of disparities in access for diagnosis and treatment in women diagnosed with breast cancer in Colombia, and to describe the main associated risk factors. Methodology: A systematic search was conducted with the terms "Breast neoplasms" AND "Health disparities" OR "Health status disparities" OR "Socioeconomic factors" AND "Colombia", in the Pubmed databases (Medline), Scielo, Cochrane, EBSCO, Ovid, Elsevier, Lilacs, Imbiomed, in Spanish, English, and Portuguese, published from January 1, 2000 back to October 31, 2019. Results: 14 publications were selected for the writing of the manuscript. It was identified that the socioeconomic level, the level of education and the type of insurance, in most of the studies, showed significant association to disparities in the disease. They also had variable effects on the risk of breast cancer and an impact in its early detection and treatment. These factors influence the full survival of the patient and their becoming disease-free. Conclusions: Health disparities of patients with breast cancer in Colombia are identified. Factors such as type of insurance, socioeconomic level, educational level were identified, which impact the delay in diagnosis and worsen the clinical condition and the quality of life of the patients.

Objetivo: determinar a existência de inequidades de acesso ao diagnóstico e tratamento do câncer de mama em mulheres da Colômbia e descrever os principais fatores de risco associados. Metodologia: se realizou uma busca sistemática com os termos: "neoplasias da mama" AND "inequidades de saúde" OR "inequidades do estado de saúde" OR "fatores socioeconómicos" AND "Colômbia", nas bases de dados Pubmed (Medline), Scielo, Cochrane, EBSCO, Ovid, Elsevier, Lilacs, Imbiomed, em espanhol, inglês e português, publicados desde o dia 1° de janeiro de 2000 a 31 de outubro de 2019. Resultados: foram selecionadas 14 publicações. Se identificou que o estrato socioeconómico, a nível educativo e o tipo de asseguramento, na maioria dos estudos, se relacionam com as inequidades enquanto à doença, com efeitos variáveis sobre o risco de câncer de seio e impacto sobre a detecção precoce e o tratamento. Estas variáveis influem sobre a supervivência total e sobre a livre da doença. Conclusões: se identificam inequidades na saúde nos pacientes com câncer de mama na Colômbia. Os fatores identificados são o tipo de asseguramento, o estrato socioeconómico baixo e a escassa formação escolar, que implicam no retraso do diagnóstico e empioram a condição clínica e a qualidade de vida das pacientes.

Angiosarcoma radioinducido de mama: reporte de caso / Radioinduced angiosarcoma of the breast: Case report / Angiossarcoma radioinduzido de mama: reporte de caso

El angiosarcoma es un tumor vascular maligno poco frecuente. Constituye menos del 2% de todos los sarcomas. Existen varias formas clínicas, una es la producida después de radioterapia, en pacientes que fueron tratadas por un cáncer de mama, con cirugía conservadora y radioterapia. Se presenta como un sarcoma de alto grado, localizado en la piel o en el tejido subcutáneo y, ocasionalmente, el parénquima mamario. El único tratamiento curativo es la cirugía, con tendencia a la recurrencia y a hacer metástasis hematógena, el pronóstico es malo, con alta tasa de mortalidad.

Angiosarcoma is a rare malignant vascular tumor. It constitutes less than 2% of all sarcomas. There are several clinical forms; the one produced after radiation therapy is that associated with patients who were treated for breast cancer with conservative surgery and radiation therapy. It presents as a high-grade sarcoma located on the skin or the subcutaneous tissue and, occasionally, the breast parenchyma. The only curative treatment is surgery, with a tendency to recurrence and visceral hematogenous metastasis, with a poor prognosis and a high mortality rate.

El angiossarcoma é um tumor vascular maligno pouco frequente. Constitui menos de 2% de todos os sarcomas. Existem várias formas clínicas, uma é a produzida depois da radioterapia, em pacientes que foram tratadas por um câncer de mama, com cirurgia conservadora e radioterapia. Se apresenta como um sarcoma de alto grau, localizado na pele ou no tecido subcutâneo e, ocasionalmente, o parênquima mamário. O único tratamento curativo é a cirurgia, com tendência à recorrência e a fazer metástasehematogênica, o prognóstico é mau, com alta taxa de mortalidade.

Using the Casper Stent in Carotid Angioplasty: A Single Center Experience

Objectives To establish the success rate in endovascular internal carotid artery (ICA) stenosis recanalization using the double-layer stent Casper-RX (Microvention, Inc 35 Enterprise, Aliso Viejo, California, United States of America) and to identify the main comorbidities in individuals with ICA stenosis, morphological characteristics of the stenosis, diagnostic methods, intraoperative complications, as well as morbidity and mortality within 30 days of the surgical procedure. Materials and Methods Retrospective analysis of 116 patients undergoing ICA angioplasty with a degree of stenosis > 70% using Casper-RX stenting who underwent this procedure from April 2015 to December 2019. Results Technical success was achieved in 99.1% of the patients. Three of them had postprocedural complications: one transient ischemic attack (TIA) and two puncture site hematomas. A cerebral protection filter was not used in only two procedures, as these consisted of dissection of the carotid. There was satisfactory recanalization and adequate accommodation of the stents in the previously stenosed arteries, with no restenosis in 99.4% of the cases. Conclusion The endovascular treatment of extracranial carotid stenoses using the Casper-RX stent showed good applicability and efficacy. Although only two cases of thromboembolic complications occurred during the procedure, fu

Low sustainability of weight loss among patients with non-alcoholic fatty liver disease

Background@#Weight loss, though difficult to attain and sustain over time, remains the cornerstone of non-alcoholic fatty liver disease (NAFLD) treatment. We aimed to describe weight changes among NAFLD patients. @*Methods@#This was a retrospective, cohort study of consecutively-identified NAFLD patients with >2 clinic visits from March2007–April2018. Weight changes from baseline were categorized into weight gain, weight loss, and no change. Baseline liver and metabolic biochemistries and non-invasive liver fibrosis tests were correlated with the final weight changes. Succeeding weight changes after the initial follow-up visits were used to determine sustainability of weight loss. @*Results@#Of the 240 patients included, 123 (51.2%), 93 (38.8%), and 24 (10%) had weight gain, weight loss, and no change, respectively. Only 12.5% had >5% weight loss. Duration of follow-up was significantly longer for patients with weight loss (p<0.001). None of the baseline demographic and laboratory data were associated with weight loss. Patients with weight loss also did not have significant changes to their biochemistries and non-invasive liver fibrosis tests compared to patients with weight gain/no change. Compared to patients with weight gain after the initial follow-up, where only 11.8% were able to lose weight on the final visit, 73.1% of patients who lost weight after the initial follow-up were able to sustain their weight loss on the final visit. @*Conclusions@#Weight loss is achieved in only a third of NAFLD patients. Although 73% of patients who lost weight initially were able to sustain it, patients who gained weight after the 1st follow-up were unlikely to lose weight on further follow-up.

The radiology department in covid-19 pandemic: approach and outcome at a semi-urban tertiary hospital

There has been an increase in the exposure of radiology staff worldwide in the first and second waves of the COVID-19 pandemic. To prevent the spread of disease to the frontline radiology staff, different departments have instituted diverse preventive and precautionary measures. However, the adaptability of the plethora of interventions available for the prevention of disease transmission depends partly on the socio-economic capability of the affected setting. Objectives: To outline the approach and outcome of a radiology department in a resource-constrained setting at University of Medical Sciences Teaching Hospitals (UNIMEDTH), Ondo State Nigeria, to the curtailment of disease transmission to the departmental staff. Materials and Methods: An observational report on the approach for curtailment of COVID-19 disease transmission to departmental staff and the outcome, at the University of Medical Sciences Teaching Hospitals (UNIMEDTH), Ondo State Nigeria. The approach utilized in such resource-constrained setting was observed between April 2020 and April 2021. This was documented by taking notes and pictures and the outcome presented. Results: Eight cases of COVID-19 infection were recorded among 66 staff of the department. This is a case rate of 12.1%. Conclusion: Our modest preventive measures helped reduce patient-to-staff and inter-staff transmission of COVID-19 virus to the minimum.

Lesiones papilares de mama: estudio clínico-patológico y sobre pronóstico en 144 casos de Medellín, Colombia / Breast papillary lesions: Clinical, pathological, and prognostic study in 144 cases in Medellin, Colombia / Lesões papilares mamárias: estudo clínico-patológico e prognóstico em 144 casos de Medellín, Colômbia

Objetivo: describir los datos sociodemográficos, las manifestaciones clínicas, los paraclínicos, el tratamiento y la recurrencia, en un grupo de pacientes con lesiones papilares. Metodología: estudio analítico de cohorte retrospectiva con fuentes secundarias de información, historias clínicas. Se incluyeron pacientes evaluados entre el 1º enero de 2016 y el 31 de diciembre de 2019. Se recopilaron datos demográficos, clínicos y paraclínicos, que fueron analizados con estadística descriptiva. Resultados: la prevalencia en la muestra fue de 4.7%; todos los casos fueron en mujeres, la media de edad fue 55,5 años; el motivo de consulta más frecuente fue alteración en la imagen de mama (n=79, 54.9%), el tamaño medio de la lesión fue 1,9 cm (rango 0,1-20). Se encontró discordancia entre el diagnóstico por biopsia cortante y el espécimen de patología en 70 (48.6%) casos, en estos se encontró infraestimación de lesiones con mayor riesgo en el 36,1% (n=52). Según la clasificación histológica, el tipo más frecuente de lesión fue el papiloma intraductal 34.7% (n=50), seguido por el carcinoma papilar en 11,8% (n=17). El tipo de cirugía más efectuado fue la cuadrantectomía, con un 68.7% (n=99). La media de seguimiento fue de 28.5 meses y se encontró recaída en siete casos (4.9%). Conclusión: las lesiones papilares comprenden un grupo heterogéneo, que incluye desde las benignas hasta aquellas con potencial maligno. Afectan a las mujeres en la quinta década de la vida, se presentan como una masa, pequeña, unilateral, sin predominio de lateralidad, de crecimiento lento. El tratamiento óptimo para las lesiones de riesgo y con atipias es la cirugía con márgenes negativos, el riesgo de recurrencia es clínicamente relevante.

Objective: to describe the sociodemographic data, the clinical and paraclinical ma-nifestations, the treatment and the recurrence, in a group of patients diagnosed with papillary lesions.Methodology:analytical study of a retrospective cohort with secondary sources of information from users' medical records in the period of January 1, 2016 to December 31, 2019. The demographic, clinical and paraclinical data collected were analyzed using descriptive statistics.Results:the prevalence in the sample was 4.7%; all cases were women, the mean age was 55.5 years; the most frequent reason for consultation was abnormal breast imaging examination (n=79, 54.9 %), the mean size was 1.9 cm (range 0,1-20). Disagreement was found between the diagnosis by sharp biopsy and the pathology specimen in 48.6% of cases (n=70); lesion underestimation with higher risk was found in 36.1% of them (n=52). According to the histological classification, the most frequent was intraductal papilloma in 34.7% (n=50), followed by papillary carcinoma in 11.8% (n=17). The type of surgery most performed was quadrantectomy, 68.7% (n=99). The mean follow-up was 28.5 months and relapse was found in 4.9% (n=7).Conclusion:papillary lesions comprise a heterogeneous group, with a spectrum that includes both benign lesions and those with malignant potential. The lesions affect women in their fifties. They become apparent as a small, unilateral mass, without a pre-dominance of laterality, and of slow growth. The optimal treatment in risk lesions and with atypia is surgery with negative margins. The risk of recurrence is clinically important.

Objetivo: descrever os dados sociodemográficos, manifestações clínicas e paraclínicas, tratamento e recorrência, em um grupo de pacientes com lesões papilares.Metodologia: estudo analítico de coorte retrospectivo com fontes secundárias de informação, prontuários. Foram incluídos os pacientes avaliados entre 1º de janeiro de 2016 e 31 de dezembro de 2019. Foram coletados dados demográficos, clínicos e paraclínicos, os quais foram analisados com estatística descritiva.Resultados: a prevalência na amostra foi de 4,7%; todos os casos eram em mulheres, a média de idade foi de 55,5 anos; o motivo de consulta mais frequente foi a alteração da imagem da mama (n = 79, 54,9%), o tamanho médio da lesão foi de 1,9 cm (variação de 0,1-20). Houve discordância entre o diagnóstico por biópsia cortante e o espécime anatomopatológico em 70 (48,6%) casos, nestes casos subestimação das lesões de maior risco em 36,1% (n = 52). De acordo com a classificação histológica, o tipo de lesão mais frequente foi o papiloma intraductal em 34,7% (n = 50), seguido do carcinoma papilífero em 11,8% (n = 17). O tipo de cirurgia mais realizada foi a quadrantectomia, com 68,7% (n = 99). O seguimento médio foi de 28,5 meses e recidiva foi encontrada em sete casos (4,9%).Conclusão: as lesões papilares constituem um grupo heterogêneo, que inclui desde as benignas até as com potencial maligno. Atingem mulheres na quinta década de vida, aparecem como uma massa, pequena, unilateral, sem predomínio da lateralidade, de crescimento lento. O tratamento ideal para lesões de risco e com atipia é a cirurgia com margens negativas, o risco de recorrência é clinicamente relevante.

Querión de Celso, aspectos diagnósticos y terapéuticos: Presentación de un caso / Kerion Celsi, diagnostic and therapeutic aspects: a case report

RESUMEN La tiña capitis es una enfermedad que afecta con mayor frecuencia a la población pediátrica; es ocasionada por hongos dermatofitos y es el querión su forma inflamatoria severa. Su diagnóstico e intervención temprana evita posibles secuelas estéticas y psicológicas en quienes lo padecen. Se presenta caso de paciente masculino de 4 años quien consultó al servicio de dermatología por cuadro de 4 meses de placa eritemato-descamativa con pústulas que progresó a única placa de predominio alopécica y adenopatías cervicales. El reporte microbiológico confirmó su diagnóstico, y el ultrasonido contribuyó al pronóstico y conducta terapéutica.

ABSTRACT Tinea capitis is a disease that most frequently affects the pediatric population caused by dermatophyte fungi, of which kerion is the severe inflammatory form of it. Its early diagnosis and intervention avoids possible aesthetic and psychological consequences in those who suffer from it. The case of a 4-year-old male patient is presented, who attend the dermatology service for 4 months of erythematous-desquamative plaque with pustules that evolved to a single plaque of predominantly alopecia and cervical lymphadenopathy. Microbiological report confirmed its diagnosis, and ultrasound contributed to the prognosis and therapeutic behavior.

Estrés, ansiedad y factores asociados en mujeres adolescentes embarazadas y no embarazadas en Medellín (Colombia) / Stress, anxiety, and associated factors in pregnant and non-pregnant adolescent women in Medellin (Colombia) / Estresse, ansiedade e fatores associados em adolescentes grávidas e não grávidas em Medellín (Colômbia)

Objetivo: Comparar el grado de ansiedad y estrés en dos grupos poblacionales de mujeres adolescentes y su asociación con el embarazo. Metodología: Estudio transversal analítico en 125 adolescentes embarazadas atendidas en el Hospital General de Medellín (Colombia) y 124 adolescentes no embarazadas estudiantes del Colegio Jorge Eliécer Gaitán de Medellín (Colombia). Las participantes respondieron la encuesta de Hamilton para ansiedad y de Holmes y Rahe para estrés psicosocial. Resultados: La mediana de edad fue 17 años (rango intercuartil o RIC=2) en las emba-razadas y 13.5 (RIC=2) en las estudiantes. En las embarazadas, la prevalencia de ansiedad fue del 68% y de estrés del 73.6%, mientras que en el grupo de no embarazadas la prevalencia de ansiedad fue del 64% (OR=1.2. IC95% 0.20-2.09. p=0.5) y la de estrés fue del 40% (OR=4.18; IC95% 2.37-7.41; p<0.01). Hubo asociación entre tener una prueba positiva para ansiedad y malas relaciones familiares, consumo de alcohol e inicio de vida sexual, mientras que hubo asociación entre test positivo para estrés y ser menor de 15 años, tener malas relaciones familiares, malas relaciones de pareja, consumo de alcohol, inicio de vida sexual y familiares con enfermedad mental. Conclusiones: No hay mayor prevalencia de ansiedad en las madres adolescentes atendidas en el Hospital General de Medellín en comparación con las adolescentes no embarazadas del Colegio Jorge Eliécer Gaitán de Medellín (Colombia). Se encontró más estrés entre las adolescentes embarazadas. Se evidenciaron como factores asociados las malas relaciones familiares, el consumo de alcohol y el inicio de vida sexual, tanto para la ansiedad como para el estrés.

Objective: To compare the levels of anxiety and stress in two population groups of adolescent women and their relation to pregnancy. Methodology: Descriptive cross-sectional study, which included 125 pregnant adoles-cents treated at the Luz Castro de Gutiérrez Hospital, and 124 non-pregnant teenage students belonging to the Jorge Eliécer Gaitán school, both located in the city of Medellín (Colombia). The participants answered the Hamilton Anxiety Rating Scale (HAM-A) and the Holmes and Rahe Stress Scale to assess psychosocial stress. Results: The median age was 17 years (interquartile range or IQR = 2) in pregnant women and 13.5 (IQR = 2) in students. In pregnant women, the prevalence of anxiety was 68% and stress was 73.6%, while in the non-pregnant group the prevalence of anxiety was 64% (OR = 1.2. 95% CI 0.20-2.09. P = 0.5) and the stress rate was 40% (OR = 4.18; 95% CI 2.37-7.41; p <0.01). An association was found between having a positive test for anxiety and bad family relationships, alcohol consumption and the beginning of sexual life, while there was an association between having a positive test for stress and being under 15 years old, having bad family relationships, bad relationships with a partner, consumption of alcohol, beginning of sexual life and relatives with mental illnesses. Conclusions: No higher prevalence of anxiety is found in adolescent mothers treated at the Hospital General de Medellín compared to non-pregnant girls from Colegio Jorge Eliécer Gaitán in Medellín (Colombia). A higher stress disorder was found among preg-nant teens. Poor family relationships, alcohol consumption and the onset of sexual life were evidenced as associated factors, both for anxiety and for stress.

Objetivo: Comparar o grau de ansiedade e estresse em dois grupos populacionais de mulheres adolescentes e sua associação com a gravidez. Metodologia: Estudo transversal analítico com 125 adolescentes grávidas atendidas no Hospital Geral de Medellín (Colômbia) e 124 adolescentes não grávidas estudantes da Escola Jorge Eliécer Gaitán de Medellín (Colômbia). Os participantes responderam à pesquisa de Hamilton para ansiedade e à pesquisa de Holmes e Rahe para estresse psicossocial. Resultados: A média de idade foi de 17 anos (intervalo interquartil ou IQR = 2) nas gestantes e 13,5 (IQR = 2) nas estudantes. Nas gestantes, a prevalência de ansiedade foi de 68% e estresse de 73,6%, enquanto no grupo de não grávidas a prevalência de ansiedade foi de 64% (OR = 1,2; IC95% 0,20-2,09. P = 0,5) e do estresse a taxa foi de 40% (OR = 4,18; IC 95% 2,37-7,41; p = <0,01). Houve associação entre ter teste positivo para ansiedade e mau relacionamento familiar, consumo de álcool e início da vida sexual, enquanto houve associação entre ter teste positivo para estresse e ser menor de 15 anos, ter relacionamento familiar ruim, mau relacionamento com companheiro, consumo de álcool, início da vida sexual e familiares com transtorno mental. Conclusões: Não há maior prevalência de ansiedade em mães adolescentes atendidas no Hospital Geral de Medellín em comparação com adolescentes não grávidas do Co-légio Jorge Eliécer Gaitán em Medellín (Colômbia). Mais estresse foi encontrado entre as adolescentes grávidas. Relações familiares precárias, consumo de álcool e início da vida sexual foram evidenciados como fatores associados, tanto para ansiedade quanto para estresse.

Lesiones multiligamentarias de rodilla asociadas a ruptura de tendón rotuliano / Complex multiligament knee injury associated with patellar tendon rupture

Resumen: Introducción: La lesión multiligamentaria de la articulación de rodilla se define como el daño a dos o más ligamentos principales. Estas lesiones son poco comunes, con una incidencia de ˂ 10:10,000. Constituyen menos de 0.02% de todas las lesiones ortopédicas. Es aún menos frecuente encontrar asociación de éstas a una ruptura completa del tendón patelar, la cual se presenta con una prevalencia 2.4%. Caso clínico: Masculino de 22 años sufrió accidente de alta velocidad, con diagnóstico de lesión multiligamentaria de rodilla izquierda estadio V de Schenck asociada a ruptura completa de tendón patelar, fue tratado en un solo tiempo quirúrgico con reconstrucción ligamentaria cuatro semanas después de evento traumático. Se obtuvo a los ocho meses un puntaje de 88.5 con el formulario IKDC 2000 para la evaluación funcional subjetiva de la rodilla. Discusión: El tratamiento quirúrgico definitivo se realiza a las cuatro semanas de la lesión. Con esto se disminuye el riesgo de inestabilidad. En nuestro caso clínico el paciente se logra integrar a las actividades de su vida diaria después de ocho meses. Para validar esta técnica como efectiva o buena para su uso, se requiere un mayor número de pacientes tratados de la misma forma. Sin embargo, se sugiere contemplar como una opción de manejo. Conclusión: Lesión poco frecuente, de tratamiento quirúrgico con un pronóstico reservado.

Abstract: Introduction: Multi-ligament injury of the knee joint is defined as damage to two or more major ligaments. They are uncommon, with an incidence of ˂ 10:10,000. They constitute less than 0.02% of all orthopedic lesions. It is even less frequent to find an association of these with a complete rupture of the patellar tendon which presents with a prevalence of 2.4%. Case report: 22 year old male; he presented a high-speed accident with a diagnosis of multi-ligament left knee injury stage V of Schenck associated with complete patellar tendon rupture treated in a single surgical time with ligament reconstruction, four weeks after traumatic event. A score of 88.5 was obtained after eight months with the IKDC 2000 form for the subjective functional evaluation of the knee. Discussion: The definitive surgical treatment is performed four weeks after the injury. This reduces the risk of instability. In our clinical case, the patient is integrated into the activities of his daily life after eight months. To validate this technique as effective or good for its use, a greater number of patients treated in the same way is required. It is, however, suggested to contemplate as a management option. Conclusion: These types of lesions are infrequent with a prognosis reserved.

Mastitis granulomatosa / Granulomatous mastitis / Mastite granulomatosa

La mastitis granulomatosa es una enfermedad rara, de etiología desconocida y de diagnóstico de exclusión luego de descartar otras causas de mastitis, como las asociadas a infecciones bacterianas y a gérmenes atípicos como hongos y tuberculosis. La incidencia ha sido difícil de determinar, pero varia del 0.3% al 1.8%. Más frecuente en mujeres en edad reproductiva, la presentación clínica más común de este tipo de mastitis es una masa mamaria de consistencia dura, unilateral, asociada a dolor, eritema, calor e hinchazón, sin fiebre. Tiende a formar abscesos únicos o múltiples con fistulización, lo que hace que se confunda con carcinoma inflamatorio o localmente avanzado. Además, tiende a ser recurrente. El diagnóstico solo puede confirmarse por histopatología, en la que se evidencian granulomas no caseificantes concentrados en lobulillos mamarios, con infiltrado linfocitario crónico, necrosis y, con frecuencia, ectasia ductal. El tratamiento es controvertido, con opciones que van desde la observación, antibióticoterapia, terapia con corticosteroides, medicamentos inmunosupresores como el metotrexato, a la cirugía con escisión local amplia.

Granulomatous mastitis is a rare disease of unknown etiology, and the diagnosis is of exclusion after ruling out other causes of mastitis such as those associated with bacterial infectious diseases and by atypical germs such as fungi and tuberculosis. the incidence has been difficult to determine but varies from 0.3 to 1.8%. More common in women of reproductive age, the most common clinical presentation is a breast mass of hard, unilateral consistency, associated with pain, erythema, heat, swelling, and without fever. It tends to form single or multiple abscesses with fistulization, which makes it possible to be confused with an inflammatory or locally advanced carcinoma. Also with tendency to recurrence. The diagnosis can only be confirmed by histopathology, it is characterized by non-caseifying granulomas concentrated in breast lobules with chronic lymphocyte infiltrate, necrosis and often ductal ectasia. The treatment is controversial, with options ranging from observation, antibiotic therapy, corticosteroid therapy, immunosuppressive medications such as methotrexate, to surgery such as wide local excision.

A mastite granulomatosa é uma doença rara, de etiologia desconhecida e de diagnóstico de exclusão logo de descartar outras causas de mastite, como as associadas a infecções bacterianas e a germens atípicos como fungos e tuberculose. A incidência há sido difícil de determinar, mas varia de 0.3% a 1.8%. Mais frequente em mulheres em idade reprodutiva, a apresentação clínica mais comum deste tipo de mastite é uma massa mamária de consistência dura, unilateral, associada a dor, eritema, calor e inchaço, sem febre. Tende a formar abscessos únicos ou múltiplos com fistulização, o que faz confundir com carcinoma inflamatório ou localmente avançado. Além disso, tende a ser recorrente. O diagnóstico só se pode confirmar por histopatologia, na qual se evidenciam granulomas não caseificantes concentrados em lóbulos mamários, com infiltrado linfocitário crônico, necrose e, com frequência, extasia ductal. O tratamento é controvertido, com opções que vão desde a observação, antibióticoterapia, terapia com corticosteroides, medicamentos imunossupressores como o metotrexato, à cirurgia com incisão local ampla.

Dominios culturales relacionados con la depresión en adultos / Cultural domains related to depression in adults / Domínios culturais relacionados com a depressão em adultos

RESUMEN Introducción: La depresión representa un problema de salud que repercute de manera importante en la estabilidad mental y calidad de vida de las personas. Estudiar los dominios culturales relacionados con esta patología es relevante para diferenciarla, pues suele confundirse con otros estados emocionales. Objetivo: Analizar los dominios culturales relacionados con la depresión en mujeres y hombres adultos. Material y métodos: Estudio mixto de consenso cultural realizado en San Luis Potosí, México, que incluyó a 163 participantes. La recolección de datos se efectuó por muestreo a conveniencia mediante listados libres, entrevistas estructuradas y sorteos por montones. Se identificaron 20 elementos categorizados en áreas temáticas, se organizaron en conjuntos jerárquicos para observar la distribución y dimensiones de los dominios culturales. Resultados: Las personas tienen nociones en común respecto a lo que implica la depresión. Los elementos relacionados con mayor frecuencia fueron: tristeza, desánimo y soledad, a su vez, la agrupación de estos mostró dos dimensiones principales: consecuencias y atención. Discusión: La literatura reporta que hay diferencias subjetivas entre la depresión y otros padecimientos, también indica que existen contrastes por sexo y que las condiciones sociales desfavorables se relacionan con malestares emocionales; sin embargo, en las dimensiones culturales no están presentes la promoción ni la prevención de esta enfermedad. Conclusiones: Considerar los dominios culturales de la población adulta con respecto a la depresión posibilita la creación de programas dirigidos a promocionar la salud y prevenir la enfermedad, así como facilitar la práctica clínica fundamentada en el contexto social y cultural de las personas.

ABSTRACT Introduction: Depression represents a health problem which has important impacts on the mental stability and quality of life. Therefore, studying the related cultural domains becomes relevant in order to differentiate this pathology from other emotional states. Objective: To analyze the cultural domains related to depression in adults. Materials and methods: This is a mixed study with cultural consensus carried out in the state of San Luis Potosi, Mexico, which included 163 participants. Data collection was based on sampling by convenience using free listings, structured interviews, and lots. Twenty elements related to the thematic areas were identified, and organized in hierarchical sets in order to observe the distributions and dimensions of the cultural domains. Results: Participants showed common notions regarding what depression implies. The most cited related elements were sadness, discouragement, and loneliness, which were grouped in two main dimensions: consequences and attention. Discussion: The literature reports the existance of subjective differences between depression and other emotional pathologies, and that these differences are influenced by sex and social conditions. Nevertheless, the related cultural dimensions are not always considered, in particular regarding the prevention of the illness. Conclusions: The precise consideration of the cultural domains which are associated with adults suffering from depression can allow the design and implementation of programs aimed at promoting health and preventing illness, as well as at fostering a clinical practice based on the social and cultural context of these persons.

RESUMO Introdução: A depressão representa um problema de saúde que reverbera de maneira importante na estabilidade mental e qualidade de vida das pessoas; estudar os domínios culturais relacionados com esta patologia é relevante para diferenciá-la, já que geralmente confunde-se com outros estados emocionais. Objetivo: Analisar os domínios culturais relacionados com a depressão em mulheres e homens adultos. Material e métodos: Estudo misto de consenso cultural realizado em San Luis Potosí, México; que incluía 163 participantes, a coleta de dados efetuou-se por amostragem a conveniência mediante listados livres, entrevistas estruturadas e classificação da pilha, identificaram-se 20 elementos categorizados por áreas temáticas, organizaram-se em conjuntos hierárquicos para observar a distribuição e dimensões dos domínios culturais. Resultados: As pessoas têm noções em comum ao respeito do que envolve a depressão. Os elementos relacionados com maior frequência foram: tristeza, desânimo e solidão; enquanto a agrupação deles mostrou duas dimensões principais: consequências e atenção. Discussão: A literatura relata que existem diferenças subjetivas entre a depressão e outras doenças, indica também que existem contrastes por sexo e que as condições sociais desfavoráveis se relacionam ao desconforto emocional, porém, nas dimensões culturais não estão presentes a promoção nem a prevenção desta doença. Conclusões: Considerar os domínios culturais da população adulta ao respeito da depressão, possibilita a criação de programas dirigidos a promover a saúde e prevenir a doença, assim como facilitar a prática clínica fundamentada no contexto social e cultural das pessoas.

Complicaciones de fracturas supracondíleas humerales en niños / Complications of supracondylar humeral fractures in children

Resumen: Introducción: Las fracturas supracondíleas representan la causa más frecuente de las lesiones del codo pediátrico (64% de la población en niños menores de ocho años). Estas fracturas pueden presentar complicaciones como: A) complicaciones previas al tratamiento: 1) neurológicas, 2) vasculares y 3) síndrome compartimental. B) complicaciones posteriores al tratamiento: 1) precoces en los primeros días tras el tratamiento: pérdida de reducción, complicaciones neurológicas, vasculares, síndrome compartimental, infección de las agujas de Kirschner, 2) complicaciones tardías en el tratamiento: deformidad angular, pérdida de movilidad, miositis osificante, necrosis avascular de la tróclea, entre otros. Objetivo: Determinar la frecuencia de las complicaciones en fracturas supracondíleas humerales en menores de ocho años. Material y métodos: Se realizó un estudio retrospectivo y observacional de cohorte en pacientes menores de ocho años en el período de Marzo de 2014 a Febrero de 2018. Resultados: Se obtuvieron 277 pacientes con los siguientes porcentajes: 3.97% presentó lesiones de cúbito varo; 1.44%, lesiones neurológicas previas al tratamiento quirúrgico; 1.44%, complicaciones neurológicas precoces al tratamiento; 0.72%, infecciones de agujas de Kirschner; 0.72%, cúbito valgo y 0.36% con pérdida de la movilidad. Conclusiones: La complicación más frecuente de las fracturas supracondíleas de húmero en este estudio fue cúbito varo y complicaciones neurológicas previas al tratamiento.

Abstract: Introduction: Supracondylar fractures represent the most frequent cause of pediatric elbow injuries, at 64%, in children under eight years old. These fractures can present complications such as: A) Complications prior to treatment: 1) neurological, 2) vascular and 3) compartment syndrome. B) Complications after treatment: 1) early, in the first days after treatment: loss of reduction, neurological, vascular, compartment syndrome, infection of Kirschner wires. 2) Late complications in treatment: Angular deformity, loss of mobility, ossifying myositis, avascular necrosis of the trochlea, others. Objective: To determine the frequency of complications in humeral supracondylar fractures in less than eight years. Material and methods: A retrospective, observational cohort study was conducted in patients under 8 years of age during the period of March 2014 to February 2018. Results: 277 patients were obtained with the following percentages: cubitus varus 3.97%, neurological lesions prior to surgical treatment 1.44%, early neurological complications to treatment 1.44%, infections of Kirschner needles 0.72%, cubitus valgus 0.72%, loss of mobility 0.36%. Conclusions: The most common complication of humerus supracondylar fractures in this study was cubitus varus and neurological complications prior to treatment.

C-reactive Protein is an Independent Predictor of Left Ventricular Mass in Offspring of Hypertensive Subjects in Nigeria

Offspring of hypertensive parents have been shown to be at increased risk of developing systemic hypertension and adverse cardiovascular events later in life. The pathological antecedents of this are thought to be alterations in the structure and function of left ventricle. However, it is currently unclear if these abnormalities are due to genetic factors or a result of higher biomarker levels such as highly sensitive C reactive protein (hsCRP). An improved understanding of the associations of hsCRP with left ventricular structure may offer additional insight. Therefore, this study aims at determining the correlation of left ventricular mass with hsCRP among offspring of hypertensive parentscomparedwith controls Methodology:A cross sectional Hospital based study, with 100 subjects and 100 controls. A questionnaire was administered to obtain relevant history, physical examination, blood tests, ECG, Echocardiography were done for the two groups. The results were analysed using SPSS 20.Results:The left ventricular mass and mass index wassignificantly elevated in the subjects compared with the control group. The median hsCRP was significantly higher in the subjects [1.85 (0.28-10.20) vs. 1.34 (0.17-8.49) mg/L: P<0.010]. It progressively increases significantly as the number of parent with hypertension increases [1.34(0.17-8.49), 2.00(0.28-9.66) and 2.54(0.91-10.20) mg/L P<0.001] from zero, to single and both parent respectively. There was a significant correlation between hsCRP levels, blood pressure, left ventricular mass and left ventricular mass index (R= 0.165, 0.316, 0.274: P= 0.021, 0.004, 0.014) respectively.Conclusion:The study shows that offspring of hypertensive parents had higher echocardiographic left ventricular mass, left ventricular mass index and hsCRP levels compared with controls and this hsCRP increases as the number of parents with hypertension increases. Blood pressure and left ventricular mass index increase with increasing Plasma hsCRP: This may suggest possible role of hsCRP in the development of hypertension and cardiac remodeling

Nanoformulations: Clinoptilolite-Based Capsule with Lecithin Shell

Microporous materials can provide interesting tools for different goals from bioimaging to the delivery ofbioactive molecules. In this study, the procedure based on cryo-approaches was designed to formulate thenanoparticles of natural clinoptilolite from the Zeolites mineral family. Applying scanning electron microscopy,clinoptilolite samples were imaged. After aging in the ethanol solution of phosphatidylcholine (lecithin),nanoparticles were encapsulated in the lecithin envelope. The adsorption of lecithin by clinoptilolitenanoparticles was studied by registering the diminution of optical density (OD 235) for ethanol/lecithin solutionat 235 nm with UV spectrometry. The kinetics of lecithin/clinoptilolite complex development was shown toexhibit intricate behavior, when the adsorption of lecithin was followed with its gradual release resulting in theincrease of lecithin content in ethanol solution back toward the original level. The size distribution for thelecithin/clinoptilolite complex was determined with a dynamic light scattering technique. To our knowledge,there are no reports of natural clinoptilolite-based platforms that were used as the for a nanosized capsule withphospholipids shell.

Adenomioepitelioma benigno de mama. Reporte de caso y revisión de la literatura / Benign breast adenomyoepithelioma. Case report and literature review / Adenomioepitelioma benigno de mama. Reporte de caso e revisão da literatura

Los adenomioepiteliomas de mama son tumores inusuales caracterizados por la proliferación bifásica de células epiteliales y mioepiteliales. Aunque la mayoría son benignos, tienen riesgo de recurrencia local y los casos con transformación maligna pueden tener riesgos de metástasis. El diagnóstico clínico e imagenológico no tiene rasgos característicos y en general se requiere de la resección completa de la lesión, para estudio microscópico y apoyo en la inmunohistoquímica. Al haber riesgo de recidiva local se recomienda resección con márgenes amplios. Para esta revisión se utilizó como fuente primaria de información la historia clínica y se realizó una búsqueda de la literatura relacionada con el uso de las palabras breast y adenomyoepithelioma, en la base de datos Pubmed, durante los últimos 10 años, en inglés y español, para discutir los aspectos relacionados con el tema.

The breast adenomyloepithelioma is an unusual tumor characterized by the biphasic proliferation of epithelial and myoepithelial cells. Although most of these tumors are benign, they may be at risk of local recurrence and few cases with malignant transformation may have chances of metastasis. The clinical and imaging diagnosis has no characteristic features and, in general, a complete resection of the lesion is required for microscopic study and support in immunohistochemistry. When risk of local recurrence is present, a resection with wide margins is recommended. The clinical history was the primary source of information on the case and, as a complement, there was a literature search, in both English and Spanish, focused on the use of the words "Breast" and "Adenomyoepithelioma" and was retrieved from Pubmed database publications from the last 10 years.

Os adenomioepiteliomas de mama são tumores incomum caracterizados pela proliferação bifásica de células epiteliais e mioepiteliais. Ainda que a maioria são benignos, tem risco de recorrência local e os casos com transformação maligna podem ter riscos de metástase. O diagnóstico clínico e de imagem não tem traços característicos e em geral se requere da ressecção completa da lesão, para estudo microscópico e apoio na imuno-histoquímica. Ao haver risco de recidiva local se recomenda ressecção com margens amplas. Para esta revisão se utilizou como fonte primária de informação a história clínica e se realizou una busca da literatura relacionada com o uso das palavras breast e adenomyoepithelioma, na base de dados Pubmed, durante os últimos 10 anos, em inglês e espanhol, para discutir os aspectos relacionados com o assunto.

The validation of the Tagalog version of the scale for depression in the medically ill (DMI-18 Tagalog) in a tertiary hospital in Metro Manila 2004

OBJECTIVES@#The aim of this study was to validate the Tagalog Version of DMI -18 and use it as a screening tool for detecting depression among medically ill patients admitted to a tertiary hospital in Metro Manila.@*METHODOLOGY@#The original version of the DMI-10 was translated to Tagalog by 3 Filipino Language teachers. The translated test and the original English version were both administered to both healthy and medically ill subjects. A non -random sample of 82 subjects were included in the study. Fifty seven (69.51%) were healthy subjects and the other 25 (30.49%) were medically ill patients. They were given both the original English Version and the translated Tagalog Version. The mean scores were gathered and compared. Each item of both versions were analyzed for reliability coefficient using the Parallel Forms Method. Then a Pearson product moment correlation coefficient was computed for both sets of scores. @*RESULTS@#Majority of the 82 subjects were female (57.31%) and the mean age was 31 years old for all. Even if the medically ill group scores were higher than the score of the normal subjects, the mean scores of the medically ill group did not meet the cut off scorevof 20 points. There was no significant difference in the mean scores of the normal and medically ill subjects from both forms of the test. @*CONCLUSION@#The DMI-18 Tagalog can be used as a screening tool for depression. It is a brief but accurate method by which to screen for depression among the medically ill Filipino patients. The study however failed to show significant clinical depression in the 25 medically ill subjects.