Dolor tóraco-abdominal: "Si miras el corazón, encontrarás la razón". Serie de casos

La isquemia miocárdica es un fenómeno secundario a la perfusión insuficiente del músculo cardíaco que en algunos casos puede ocurrir de forma aguda llevando a la necrosis celular y constituyendo el infarto agudo al miocardio (IAM). A pesar de que el diagnóstico de IAM es principalmente clínico, en ciertos casos en que no se sospeche de forma activa por presentar síntomas no típicos de isquemia miocárdica, el diagnóstico puede sugerirse por la Tomografía Computarizada (TC), que puede mostrar hallazgos sugerentes de IAM. A continuación, se comunica una serie de 4 casos clínicos con diagnóstico imagenológico incidental de IAM.

Myocardial ischemia is secondary to myocardial under perfusion. It can develop acutely leading to cell necrosis and myocardial infarction (AMI), or have a chronic course. Though the diagnosis of AMI is mainly clinical, in certain cases the symptoms may be atypical and the diagnosis can be suggested by images such as Computed Tomography (CT). Herein we report a series of 4 clinical cases with diagnosis of AMI following incidental CT imaging. There was an abdominal pain in 3 patients and a cervical pain in the remaining one. CT scan showed a hypodense myocardial image. The final diagnosis was confirmed by the appropriate laboratory and angiographic methods.

Estudio de la variación de la inclinación de la cabeza y la evolución de la dentición - Parte III

El objetivo de esta investigación fue estudiar la variación de la Posición Natural de Cabeza (PNC) entre personas con dentición mixta segunda fase y dentición permanente, mediante fotogrametría facial. Para esto se realizó un estudio comparativo observacional analítico. La muestra estuvo conformada por 80 voluntarios divididos en dos grupos de 40 participantes cada uno. Se utilizó fotografías faciales de perfil estandarizadas en PNC. Mediante el software Photoshop® se trazó el plano Intertrágico-Exocanto (t-ex) y se midió el ángulo formado respecto a la horizontal verdadera para determinar la inclinación de la PNC. El valor de este ángulo se obtuvo mediante el software UTHSCSA ImageTool 3.0®. Los datos fueron tabulados en una planilla Excel (Microsoft® Excel® 2016) y analizados estadísticamente en el programa Stata 14 S/E®. Se observaron diferencias estadísticas en la inclinación de la PNC entre los grupos, con valores promedio 26.17° y 33.44° para dentición mixta segunda fase y permanente respectivamente, con una diferencia promedio de 7.27°. Se concluyó que la PNC de personas con dentición permanente presenta una rotación antihoraria respecto a personas con dentición mixta segunda fase.

This research aimed at studying the variation of the Natural Head Position (NHP) between people with second transitional mixed dentition and permanent dentition, using facial photogrammetry. For this, an analytical observational comparative study was performed. The sample consisted of 80 volunteers divided into two groups of 40 participants each. Using standardized profile facial photographs in NHP and Photoshop® software, the intertragic-exocanthion plane (t- ex) was traced. The angle formed to the true horizontal was measured to determine the inclination of the NHP using the UTHSCSA ImageTool 3.0® software. The data were tabulated in an Excel Spreadsheet (Microsoft® Excel® 2016) and analyzed with Stata 14 S/E® software. Statistical differences in the inclination of the NHP between groups were observed, with average values ​​of 26.17° for second transitional mixed dentition and 33.44° for permanent dentition, with an average difference of 7.27°. It was concluded that the NHP of people with permanent dentition shows an anti-clockwise rotation in relation to people with second transitional mixed dentition.

Complicaciones postoperatorias en fractura de órbita: experiencia en el Hospital del Trabajador de Santiago

Objetivo: Describir la experiencia del equipo de cirugía maxilofacial del Hospital del Trabajador en el manejo de las fracturas de órbita. Materiales y Método: Estudio retrospectivo de 42 pacientes consecutivos operados por fractura de órbita en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador entre enero de 2016 y diciembre de 2017. Se tabularon datos demográficos, información del trauma, tipo de fractura, fracturas asociadas, tratamiento y seguimiento. Resultado: De los 42 pacientes, la mayoría eran hombres (73,8%) con edad promedio de 40 ± 12,24 años. Los principales síntomas al ingreso fueron equimosis (64,3%), edema periocular (54,8%), hemorragia subconjuntival (33,3%) y diplopía (26,2%). La pared orbitaria más frecuentemente afectada fue el piso de la órbita (85,7%). Las fracturas se presentaron de forma aislada en 35,7% de los casos y asociada a otra fractura de la cara en 64,3%. Post cirugía, la tasa de complicación fue de 16,7%, producto de diplopía y enoftalmos leves que solo requirieron tratamientos conservadores para su resolución. Discusión: La baja tasa de complicaciones se debe a la experiencia del equipo médico con un seguimiento a largo plazo, la medición de volúmenes orbitarios, imagenología intraoperatoria, utilización de malla prefabricada y asistencia endoscópica. Conclusiones: Un adecuado diagnóstico y evaluación son fundamentales para el tratamiento de la fractura de órbita. Los datos demográficos, las características de las fracturas y las complicaciones descritas fueron muy similares a lo reportado por otras experiencias, mientras que la tasa de complicaciones fue menor.

Aim: To describe the experience of the Maxillofacial Surgical team of Hospital del Trabajador de Santiago in the management of orbital fractures. Materials and Methods: Retrospective study of 42 patients operated consecutively between January of 2016 and November of 2017 at Hospital del Trabajador de Santiago by the Maxillofacial Surgery team due to orbital fracture. The demographic data was tabulated and then a comparison between isolated and combined orbital fractures was made. Results: Of 42 patients most were men (73.8%) with an average age of 40±12.24 years. At admission the main symptoms were ecchymosis (64.3%), periorbital edema (54.8%), subconjunctival hemorrhage (33.3%) and diplopia (26.2%). The most frequently affected orbital wall was the floor (85.7%). Isolated fractures accounted for 35.7% of the cases and those associated with other facial fractures for 64.3%. The postoperative complication rate was 16.7% due to diplopia and enophthalmos. Both complications were mild and only required conservative management. Discussion: The low complication rate might be due to the experience of the surgical team in the management of orbital fractures, long-term following, orbital volume measurements, intraoperative imaging, the use of prefabricated mesh and endoscopic guidance. Conclusión: An adequate diagnosis and evaluation are fundamental for orbital fracture treatment. Demographic data, fracture characteristics and the complications described were similar to those reported by other studies, while the rate of complications was lower than those experiences.

Double transposition flap for lower eyelid reconstruction: case report of a new surgical approach / Retalho de dupla transposição para reconstrução de pálpebra inferior: relato de caso de uma nova abordagem cirúrgica

Introduction: Non-melanoma tumors frequently affect the lower palpebral region and constitute a challenge for reconstructing the surgical wound without causing functional or aesthetic changes. Primary closure is generally impossible, and flaps are preferred over grafts as they generate less eyelid retraction. This article aims to describe a new surgical reconstruction technique. Method: A modified McGregor flap technique is described for correcting a surgical defect greater than 50% of the anterior lamella of a recurrent basal cell carcinoma lesion in the lower eyelid. Results: The patient was evaluated on the 7th, 14th, 21st, and 45th postoperative days. She presented a good functional and aesthetic response to the technique used. Conclusion: Using the double transposition flap, we demonstrate a new technique for closing defects larger than two-thirds in the lower eyelid.

Introdução: Os tumores não melanomas acometem frequentemente a região palpebral inferior e consistem em um desafio para a reconstrução da ferida operatória sem ocasionar alteração funcional ou estética. O fechamento primário geralmente não é possível e os retalhos são preferenciais aos enxertos por gerarem menor retração palpebral. Este artigo tem como objetivo descrever uma nova técnica de reconstrução cirúrgica. Método: Descreve-se técnica modificada do retalho de McGregor para correção de defeito cirúrgico maior que 50% da lamela anterior, de lesão recidivada de carcinoma basocelular localizada em pálpebra inferior. Resultados: Paciente foi avaliada no 7º, 14º, 21º e 45º dia de pós-operatório. Apresentou boa resposta funcional e estética com a técnica utilizada. Conclusão: Demonstramos uma nova técnica de fechamento de defeitos maiores do que dois terços na pálpebra inferior através do retalho de dupla transposição.

Defunciones por mieloma múltiple en Chile entre 2018-2022 por sexo, edad, temporalidad y región nacional / Deaths from multiple myeloma in Chile between 2018-2022 by sex, age, temporality, and national region

Introducción: Chile es el país con la mayor tasa de mortalidad por mieloma múltiple (MM) en Latinoamérica, sin embargo, no existen estudios actualizados que describan esto. El objetivo de este estudio es describir las defunciones por MM según año, sexo, grupo etario y región en Chile, en el periodo 2018-2022. Metodología: Estudio ecológico de las defunciones por MM en el periodo 2018-2022 según año, sexo, grupo etario y región (n=2433). Se calculó el número de defunciones y las tasas de mortalidad por causa específica. Datos obtenidos del Departamento de Estadísticas e Información de Salud. No se requirió comité de ética. Resultados: El promedio de la tasa de mortalidad por año fue de 2.51 por 100.000 habitantes en el periodo estudiado, y fue menor a este valor en 2020 y 2021. El sexo masculino obtuvo un 52.2% del total de las defunciones. Las personas de 80-89 años obtuvieron la mayor tasa de mortalidad (27.57 por 100.000 habitantes). La región con mayor tasa de mortalidad es la de Ñuble (3.45 por 100.000 habitantes). Discusión: La disminución en la tasa de mortalidad para MM en los años 2020-2021 podría deberse al COVID-19. Las tasas entre sexos son similares, pese a que las estadísticas internacionales indican mayor prevalencia en hombres. Los grupos etarios más afectados son los de mayor edad, pues es factor de riesgo para MM. Las regiones con mayor tasa de mortalidad son las del centro-sur, aunque es difícil establecer causalidad. Las investigaciones respecto a este tema en Chile son escasas, este trabajo podría ser útil para futuras investigaciones.

Introduction: Chile is the country with the highest mortality rate from multiple myeloma (MM) in Latin America, however, there are no updated studies that describe this. The objective of this study is to describe the functions by MM according to year, sex, age group and region in Chile, in the period 2018-2022. Methodology: Ecological study of the functions by MM in the period 2018-2022 according to year, sex, age group and region (n=2433). The number of deaths and cause-specific mortality rates were calculated. Data obtained from the Department of Health Statistics and Information. No ethics committee was required. Results: The average mortality rate per year was 2.51 per 100,000 inhabitants in the period studied, and it was lower than this value in 2020 and 2021. The male sex obtained 52.2% of all deaths. People aged 80-89 years had the highest mortality rate (27.57 per 100,000 inhabitants). The region with the highest mortality rate is Ñuble (3.45 per 100,000 inhabitants). Discussion: The decrease in the mortality rate for MM in the years 2020-2021 could be due to COVID-19. The rates between sexes are similar, despite the fact that international statistics indicate a higher prevalence in men. The most affected age groups are the older ones, as it is a risk factor for MM. The regions with the highest mortality rate are those of the center-south, although it is difficult to establish causality. Research on this topic in Chile is scarce, this work could be useful for future research.

Asociación entre la calidad de atención de enfermería percibida y nivel de satisfacción por pacientes hospitalizados / Association between perceived quality of nursing care and level of satisfaction by hospitalized patients

OBJETIVO: El objetivo de este estudio fue determinar la asociación entre la calidad de la atención percibida y el nivel de satisfacción por pacientes hospitalizados en una institución de salud en México. MÉTODO: Se trata de un estudio cuantitativo, descriptivo-correlacional, de corte transversal. La muestra (n=37) se conformó por pacientes hospitalizados en una institución se segundo nivel de atención en Guanajuato. Las variables, calidad percibida de la atención de Enfermería y satisfacción global se midieron utilizando el instrumento de SERVQHOS-E de 17 ítems y dos subescalas (tangibles e intangibles). Los datos se analizaron mediante estadística descriptiva y la prueba Chi-cuadrada de Pearson. El programa SPSS auxilió en el procesamiento de datos. RESULTADOS: El 51% de los participantes se identifican como hombres con una edad promedio de 42.97 años. La Calidad Intangible la calificaron como regular (57%), mientras que la Calidad Tangible como buena (65%). El nivel de satisfacción fue evaluado como Satisfecho (49%) y Muy Satisfecho (51%). Se encontró una asociación entre los factores intangibles con el nivel de satisfacción (p = .015); sin embargo, en los factores tangibles no se encontró asociación (p = .248). CONCLUSIONES: Estos resultados podrían reflejar la formación rigurosa y de calidad de los enfermeros que laboran en esta institución. Sin embargo, también podrían indicar las carencias de la institución en cuanto a equipo tecnológico para brindar mejores servicios de salud.

OBJECTIVE: The aim of this study was to determine the association between the perceived quality of care received and the level of satisfaction of hospitalized patients in Guanajuato, Mexico. METHODS: This is a quantitative, descriptive-correlational, cross-sectional study. The sample (n=37) was made up of patients hospitalized in a second level care institution in Guanajuato, Mexico. The variables, perceived quality of nursing care and overall satisfaction were measured using the SERVQHOS-E instrument with 17 items and two subscales (tangible and intangible). Data were analyzed using descriptive statistics and Pearson's Chi-square test. The SPSS program helped in data processing. RESULTS: 51% of the participants identified themselves as men with an average age of 42.97 years. The Intangible Quality was rated as regular (57%), while the Tangible Quality was good (65%). The level of satisfaction was evaluated as Satisfied (49%) and Very Satisfied (51%). An association was found between the intangible factors with the level of satisfaction (p = 0.015); however, no association was found for tangible factors (p = 0.248). CONCLUSIONS: These results could reflect the rigorous and quality training of the nurses who work in this institution. However, they could also indicate the institution's shortcomings in terms of technological equipment to provide better health services.

Evaluación de la satisfacción de pacientes chilenos atendidos por telemedicina en consultas nutricionales / Evaluation of the Satisfaction of Chilean Patients Attended by Telemedicine in Nutritional Consultations

La telemedicina, a través del uso de plataformas de videoconferencias por Internet, se encuentra cada vez más extendida en Chile, debido a la pandemia de COVID-19 y las restricciones para controlar el virus. El nutricionista no es ajeno a esta situación y ha tenido que modificar las consultas para dar respuesta a esta nueva realidad. Sin embargo, no existe suficiente información respecto al nivel de satisfacción de los usuarios de la telemedicina, que emplea este profesional. El objetivo de la investigación fue describir la percepción de la satisfacción usuaria relacionada con las consultas nutricionales mediante la telemedicina, realizadas durante la pandemia. Se realizó un estudio observacional, descriptivo y transversal. Se reclutaron 62 pacientes de Santiago de Chile, quienes fueron atendidos en una consulta nutricional por videoconferencia. Se diseñó un cuestionario online constituido por seis ítems para determinar la aceptabilidad de la consulta nutricional por telemedicina. El rol del nutricionista en la consulta nutricional por videoconferencia tuvo un grado de satisfacción superior al 70 por cientoEl 62,9 por ciento de los encuestados prefiere que la consulta nutricional sea combinada. Solo el 50 por ciento señala que la plataforma de videoconferencia zoom favorece la relación nutricionista-paciente. La consulta nutricional por telemedicina permite controlar el estado nutricional del paciente sin necesidad de asistir de manera presencial, lo que mejora el acceso a la atención. Existe un nivel elevado de aceptación por parte de los pacientes que han recibido atención nutricional por telemedicina(AU)

Telemedicine, through the use of Internet videoconferencing platforms, is increasingly widespread in Chile, as a consequence of the COVID-19 pandemic and the restrictions to control the virus. The nutritionist is no stranger to this situation and has had to modify consultations to respond to this new reality. However, there is insufficient information regarding the level of satisfaction of telemedicine users employed by this professional. The objective of the research was to describe the perception of user satisfaction related to nutritional consultations through telemedicine, carried out during the pandemic. An observational, descriptive and cross-sectional study was developed. Sixty-two patients were recruited from Santiago, Chile, who were attended in a nutritional consultation by videoconference. An online questionnaire consisting of six items was designed to determine the acceptability of the nutritional consultation by telemedicine. The role of the nutritionist in the nutritional consultation by videoconference had a degree of satisfaction higher than 70percen. 62.9percentof the respondents prefer the nutritional consultation to be combined. Only 50percent indicated that the zoom videoconferencing platform favors the nutritionist-patient relationship. The telemedicine nutritional consultation makes it possible to monitor the patient's nutritional status without the need to attend in person, which improves access to care. There is a high level of acceptance by patients who have received nutritional care via telemedicine(AU)

Trauma surgery workforce in the state of Rio Grande do Sul, Brazil / Perfil do cirurgião do trauma no Rio Grande do Sul

ABSTRACT Objective: to describe the current scope of certified trauma surgeons trained in the state of Rio Grande do Sul, including demographic data, geographic distribution, remuneration, and perspectives related to this specialty. Method: cross-sectional survey based on information collected through an electronic questionnaire sent to potential participants. Results: the response rate was 64% (n=75). There was a predominance of males (72%) with a mean age of 43 years. Most surgeons graduated from the Hospital de Pronto Socorro de Porto Alegre, and work in referral centers for trauma surgery in the capital and metropolitan region. More than 60% did not have any other training in a surgical subspecialty, though only a third stated that trauma surgery is their main source of income. Conclusion: trauma centers are poorly distributed and most surgeons work in referral hospitals in the metropolitan region of Porto Alegre. Due to the lack of recognition, limited financial income and shift work patterns, the career in trauma surgery care is unattractive, with only one third of surgeons performing most of their activities in this specialty.

RESUMO Objetivo: descrever o perfil dos cirurgiões do trauma formados no estado do Rio Grande do Sul, incluindo dados demográficos, distribuição geográfica, remuneração, e perspectivas relacionadas à área de atuação. Método: estudo transversal do tipo inquérito, baseado em informações coletadas por meio de questionário enviado via plataforma digital para os profissionais da amostra em questão. Resultados: a taxa de resposta dos questionários foi de 64% (n=75). Houve predomínio do sexo masculino (72%) com idade média de 43 anos. A maior parte dos profissionais foi graduada pelo Hospital de Pronto Socorro de Porto Alegre, e atua em serviços de referência em Cirurgia do Trauma na capital e região metropolitana. Mais de 60% não realizou outra formação em subespecialidade cirúrgica, embora apenas um terço dos profissionais tenha declarado que a Cirurgia do Trauma seja sua principal fonte de renda. Conclusão: os centros de trauma são mal distribuídos e a maioria dos profissionais atua em hospitais de referência da região metropolitana de Porto Alegre. Devido ao baixo reconhecimento, incentivo financeiro limitado e desgaste da modalidade de trabalho em regime de plantão, a carreira com dedicação exclusiva na área de Cirurgia do Trauma é pouco atrativa, com apenas um terço dos profissionais desempenhando a maior parte de suas atividades na área.

Ciencias sociales en contextos de represión: Análisis bibliométrico de la producción histórica de la Corporación de Estudios para Latinoamérica, Chile (1979-1989)

Este artículo presenta un análisis bibliométrico de la producción científica de la Corporación de Estudios para Latinoamérica (CIEPLAN), el centro de estudios más importante durante la dictadura y transición democrática en Chile. El análisis se realiza sobre un conjunto de registros bibliográficos (n = 145), referencias (n = 4.055) e información biográfica de los autores, durante 1979-1989. Se analizan tres dimensiones: producción científica y áreas temáticas; colaboración y coautoría; y referencias o consumo de información. Se utiliza estadística descriptiva, modelamiento temático no supervisado y Análisis de Redes Sociales (SNA, por sus siglas en inglés). Los resultados muestran una tendencia constante en la producción científica y temas centrados en tópicos clásicos de la economía asociados con temas de desigualdad y política. Además, los análisis de colaboración y referencias muestran la existencia de una comunidad compuesta por reconocidos académicos y miembros de la élite política chilena centrales en la producción intelectual y en la red de referencias. Estos hallazgos permiten denominar a CIEPLAN como una de las principales comunidades epistémicas durante la recuperación y transición democrática chilena, en específico, durante los primeros gobiernos democráticos dónde varios miembros fueron reclutados para asumir importantes cargos en el ejecutivo. Hasta hoy, estos actores siguen influenciando el proceso de formulación de políticas públicas en Chile.

This paper presents a bibliometric analysis of the Corporación de Estudios para Latinoamérica (CIEPLAN in Spanish) scientific production. This was the most important think tank during the dictatorship and democratisation in Chile. The analysis is carried out based on bibliographic entries (n = 145), references (n = 4,055), and biographical information of the authors from 1979 to 1989. Three dimensions are analysed: scientific production and topics, collaboration and co-authorship, and references or information consumption. We use descriptive statistics, unsupervised topic modelling, and Social Network Analysis (SNA). The results reveal a constant trend in the scientific production and classic topics of the economy associated with inequality and political issues. Moreover, the collaboration and citation analyses show the existence of a community composed of recognised academics and members of the Chilean political elite who were central in the intellectual production and the references' network. These findings allow us to name CIEPLAN as one of the central epistemic communities during Chile's democratic recovery and transition, specifically during the first democratic governments, where a number of members were recruited to assume important positions in the executive. To this day, these actors continue influencing the policy-making process in Chile.

Evaluación del conocimiento en dolor orofacial de los docentes de la Facultad de Odontología de la Universidad Finis Terrae / Evaluation of the orofacial pain knowledge of the Dental School professors of the University Finis Terrae

Introducción: El Dolor Orofacial (DOF) es una forma frecuente de dolor percibido en la cara y/o cavidad bucal. Puede ser causado por enfermedades o trastornos de las estructuras regionales, disfunción del sistema nervioso o por derivación de fuentes distantes." (International Association for the Study of Pain, s. f.) Esta condición presenta una alta prevalencia, y la literatura internacional demuestra una deficiencia en el conocimiento de los profesionales en DOF. Objetivo General: Determinar el conocimiento en Dolor Orofacial en los docentes de la Facultad de Odontología de la Universidad Finis Terrae en el año 2021. Material y Método: Se llevó a cabo un estudio descriptivo de corte transversal con componente analítico, utilizando un muestreo no probabilístico por conveniencia de voluntarios, a quienes se les realizó una encuesta validada de la literatura científica que fue adaptada a la lengua española, evaluando parámetros sociodemográficos, percepción y conocimiento respecto al diagnóstico, signos y síntomas clínicos de afecciones de DOF. Resultados: Se pudo observar un conocimiento aceptable de los participantes, en donde el 60% respondió al menos cinco enunciados de forma correcta. Se concluyó que el conocimiento de los docentes de la Facultad de Odontología de la Universidad Finis Terrae fue superior a los registros encontrados en la literatura científica. Si bien este estudio cuenta con algunas limitaciones, permite entregar una base para próximas investigaciones, fomentando la instauración de cursos actualizados en DOF, otorgando un nuevo enfoque a la odontología, en donde se desarrollen profesionales integrales y capaces de diagnosticar, tratar o manejar estas condiciones.

Introduction: Orofacial pain (OFP) is a common form of perceived pain in the face and/or oral cavity. It may be caused by disease or disorders of regional structures, dysfunction of the nervous system, or by referral from distant sources."(International Association for the Study of Pain, s. f.) This condition presents a high prevalence, and the international literature demonstrates a deficiency in the knowledge of OFP professionals. General Objective: To determine the knowledge of Orofacial Pain in the teachers of the Faculty of Dentistry of the Finis Terrae University in the year 2021. Material and Method: A descriptive cross-sectional study with an analytical component was carried out, using a non- probabilistic convenience sampling of volunteers, who were given a validated survey from the scientific literature that was adapted to the Spanish language, evaluating sociodemographic parameters, perception and knowledge regarding diagnosis, clinical signs and symptoms of OFP conditions. Results: It was possible to observe an acceptable knowledge of the participants, where 60% of them answered at least five statements correctly. It was concluded that the knowledge of the teachers of the Faculty of Dentistry of the Universidad Finis Terrae was superior to the records found in the scientific literature. Although this study has some limitations, it provides a basis for future research, encouraging the establishment of updated courses in OFP, providing a new approach to dentistry, in which comprehensive professionals capable of diagnosing, treating or managing these conditions are developed

Estudio retrospectivo. Influencia de la Terapia Kinesiológica Temprana en el uso de Casco Modelador Craneal / Retrospective study. Influence of early physical therapy on the need to wear a skull molding helmet

Introducción. La plagiocefalia no sinostósica es una condición de salud caracterizada por una asimetría de cráneo que tiene diversas consecuencias en el desarrollo. Los principales tratamientos son la kinesioterapia y el casco de moldeado craneal (CMC). Objetivo. Evidenciar la influencia de la kinesioterapia temprana en la necesidad de usar casco modelador craneal. Métodos. Se realizó un estudio cuantitativo, descriptivo y retrospectivo en lactantes mayores de tres meses ingresados al Centro de Rehabilitación Integral de Carabineros (CRICAR) con diagnóstico confirmado de plagiocefalia mediante la técnica de craneometría. Se recopilaron datos de 39 pacientes diagnosticados con plagiocefalia, evaluados y tratados entre 2017 y 2019. Se dividieron en dos grupos, ingreso temprano (bajo los 5,5 meses de edad cronológica) e ingreso tardío (sobre los 5,5 meses de edad cronológica). Resultados. Al realizar un análisis bivariado, se obtuvo que 9 de 20 pacientes tuvieron que usar CMC en el grupo de ingreso tardío, y solo 4 de 19 pacientes en el grupo de ingreso temprano. Al contrastar la razón de riesgo de usar CMC en el grupo expuesto versus el grupo no expuesto se obtiene que es 3 veces mayor, sin embargo, esta diferencia no es estadísticamente significativa (OR=3.06, IC95% 0.6-16.8) Conclusiones. El principal resultado de este estudio es la disminución en la diferencia de diagonales evaluadas con craneometría. Además, se ha observado que en nuestra muestra el uso de CMC es tres veces mayor cuando el ingreso a terapia kinesiológica es tardío.

Introduction. Non-synostotic plagiocephaly is health condition characterized by a skull asymmetry that has various developmental consequences. The main treatments are kinesiotherapy and cranial molding helmet (CMH). The purpose of this study is to evidence the influence of early kinesiotherapy on the need to use CMH. Methods. A quantitative, descriptive and retrospective study of infants older than three months, admitted to the Carabineros Comprehensive Rehabilitation Center (CRICAR) since January 2017 with a confirmed diagnosis of plagiocephaly by craniometry technique was performed. Data were collected from 39 patients diagnosed with plagiocephaly, evaluated and treated between 2017 and 2019. They were divided into two groups, early admission (under 5.5 months of chronological age) and late admission (over 5.5 months of chronological age). Results. When performing a bivariate analysis, we obtained that 9 out of 20 patients had to use CMC in the late admission group, and only 4 out of 19 patients had to use it in the opposite group. When contrasting the oods ratio of using CMC in the exposed group versus the non-exposed group we obtain that it is 3 times higher, however, this difference is not statistically significant (OR=3.06, IC95% 0.6-16.8). Conclusions. The main result of this study is the decrease in the difference in diagonals assessed with craniometry. In addition, it has been observed that in our sample the use of CMC is three times higher when admission to physical therapy is late.

Enseñanza histológica e histopatológica a través de microscopía virtual, una oportunidad en odontología / Virtual microscopy in histological and histopathological teaching, an opportunity in dentistry

RESUMEN La microscopía virtual (MV) está siendo ampliamente implementada en educación y podría llevar a reemplazar a la microscopía óptica (MO). Objetivo: Proporcionar una revisión de la literatura a partir de las preguntas ¿Cuál es la percepción de académicos y estudiantes? y ¿Cuál es el desempeño de los estudiantes? respecto a la enseñanza de histología y/o histopatología con MV en odontología. Material y métodos: Se consultaron las bases de datos: Pubmed, Scielo, Science Direct y Scopus, y 10 artículos fueron seleccionados. Resultados: La totalidad de estudios que evaluaron percepción y desempeño académico obtuvieron resultados a favor de la MV. Conclusiones: La MV tiene un futuro prometedor, pero más estudios con metodologías similares y que consideren la percepción de los académicos son requeridos.

ABSTRACT Virtual microscopy (VM) is being widely implemented in education and could lead to the replacement of light microscopy (LM). Objective: To provide a review of the literature based on the questions: What is the perception of academics and students? and What is the performance of students? regarding the teaching of histology and/or histopathology with VM in dentistry. Material and methods: The following databases were consulted: Pubmed, Scielo, Science Direct and Scopus, and 10 articles were selected. Results: All the studies that evaluated perception and academic performance obtained results in favor of VM. Conclusions: VM has a promising future, but more studies with similar methodologies and that consider the perception of academics are required.

Efectos posturográficos de la maniobra de Epley en pacientes con vértigo posicional paroxístico del canal posterior / Posturographic effects of the Epley maneuver on patients with benign paroxysmal positional vertigo of the posterior canal

Resumen Introducción: El vértigo posicional paroxístico benigno (VPPB) es la afección periférica más común en las enfermedades otoneurológicas. Con el reposicionamiento de partículas se busca eliminar el vértigo y sus síntomas asociados como lo son el mareo residual y la inestabilidad. Objetivo: Determinar si la maniobra de reposicionamiento de Epley (MRE) produce una modificación significativa del control postural (CP) en aquellos pacientes con VPPB de canal semicircular posterior (VPPB-CSC-P). Material y Método: Se realizó un estudio descriptivo prospectivo en una muestra de 21 pacientes con diagnóstico de VPPB-CSC-P. Comparamos el desplazamiento, la velocidad y el área del centro de presión (CoP) antes y después de la MRE. Resultados: La velocidad y el área de la CoP estudiada por posturografía computarizada muestra una disminución significativa en sus valores después de la MRE, mientras que el desplazamiento de la CoP se mantuvo sin cambios. Conclusión: La MRE ejecutada en pacientes con VPPB-CSC-P produce una modulación en el control de la CoP, demostrada por la disminución de la velocidad y el área de desplazamiento de la CoP. El éxito de la MRE produce modulación del CP.

Abstract Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral condition in otoneurologic diseases. With the repositioning of particles, the aim is to eliminate vertigo and its associated symptoms, such as residual dizziness and instability. Aim: To determine if the Epley repositioning maneuver (ERM) produces a significant modification of postural control (PC) in those patients with posterior semicircular canal BPPV (BPPV-CSC-P). Material and Method: A prospective descriptive study was carried out in a sample of 21 patients diagnosed with BPPV-CSC-P. We compared the displacement, velocity, and area of the center of pressure (CoP) before and after the Epley repositioning maneuver. Results: The velocity and the area of the CoP studied by computed posturography show a significant decrease in its values after the MRE, while the CoP shift remained unchanged. Conclusion: ERM performed in patients with BPPV-CSC-P produces an improvement in the control of the CoP, demonstrated by the decrease in the speed and the area of movement of the CoP. The success of the MRE produces modulation of the PC.

Virtual and Augmented Reality in Cardiac Surgery

Abstract Virtual and augmented reality can be defined as a three-dimensional real-world simulation allowing the user to directly interact with it. Throughout the years, virtual reality has gained great popularity in medicine and is currently being adopted for a wide range of purposes. Due to its dynamic anatomical nature, permanent drive towards decreasing invasiveness, and strive for innovation, cardiac surgery depicts itself as a unique environment for virtual reality. Despite substantial research limitations in cardiac surgery, the current literature has shown great applicability of this technology, and promising opportunities.

Estudio comparativo de la actividad anti-fúngica de extractos secuenciales de Fuchsia lycioides contra Candida sp / comparative study of the antifungal activity of sequencial extracts of Fuchsia lycioides against Candida sp

The genus Fuchsia is generally used in herbal preparations to treat conditions caused by microorganisms. Based on the popular use of this type of plants, the objective of this study was to obtain sequential extracts of increasing polarity from the branches of Fuchsia lycioides by maceration at room temperature and by the Soxhlet method at 60ºC, to later evaluate the antifungal capacity of the extracts against different clinical isolates of the Candida genus. The ethyl acetate extract exhibited strong anti-fungal activity, selectively inhibiting C. albicans strains with MIC and CMF values of 10 and 15 µg/mL, respectively; comparable with the drug itraconazole®. The analysis of the extract by GC-MS showed a high concentration of terpenoids (mainly phytol) and phenylpropanoids (mainly cinnamic acid), possibly responsible for the antifungal activity of the ethyl acetate extract of F. lycioides.

El género Fuchsia se usa generalmente en preparaciones de hierbas para tratar afecciones provocadas por microorganismos. En base al uso popular de este tipo de plantas, el objetivo de este estudio fue obtener los extractos secuenciales de polaridad creciente de las ramas de Fuchsia lycioides por maceración a temperatura ambiente y por el método Soxhlet a 60ºC, para luego evaluar la capacidad antifúngica de los extractos frente a diferentes aislados clínicos del genero Candida. El extracto de acetato de etilo exhibió una fuerte actividad antifúngica inhibiendo en forma selectiva las cepas de C. albicans con valores de CMI y de CMF de 10 y 15 µg/mL, respectivamente; comparables con el fármaco itraconazol®. El análisis del extracto por CG-EM mostró una alta concentración de terpenoides (principalmente fitol) y fenilpropanoides (principalmente ácido cinámico), posibles responsables de la actividad antifúngica del extracto de acetato de etilo de F. lycioides.

Portocath insertion technique: retrospective study & step-by-step surgical description without tunneling in a high-complexity service / Técnica de inserção de portocath: estudo retrospectivo & descrição cirúrgica do passo a passo sem tunelização em serviço de alta complexidade

ABSTRACT Objective: to demonstrate that the use of the portocath implantation technique without tunneling the catheter is not associated with a higher rate of complications in the short or long term. In addition, we aim to improve the implantation technique of the portocath device, with the presentation of a step-by-step guide for surgeons in training. Methods: this is a retrospective descriptive study, with analytical components. Data were analyzed using information extracted from electronic medical records linked to the National Health Care procedure code between the years 2019-2020. Results: none of the 94 procedures resulted in complications on the day they were performed. Complications were recorded seven days after the procedure in only two patients (2.13%). Intraoperative radioscopy had been performed in both cases. Thirty days afters the procedure, complications were observed in two patients among the remaining 92 (2.17%), both undergoing catheter implantation without tunneling. There were no complications in the six months after portocath implantation in 57.4% of patients and there is no information about the other 42.6%. Conclusion: the portocath insertion technique without tunneling is a safe outpatient procedure, with a low risk of complications, and can be adopted to shorten procedure time and patient discomfort, without functional or safety impairments. There was no association of not tunneling the catheter, laterality of the punctured vein and performing radioscopy in the transoperative period with the rate of complications.

RESUMO Objetivo: demonstrar que a utilização da técnica de implantação do portocath sem a etapa de tunelização não está associado a maior taxa de complicações a curto ou longo prazo. Além disso, almeja-se aperfeiçoar a técnica da implementação do dispositivo portocath, com a apresentação de um guia passo a passo para conduzir os cirurgiões em formação. Métodos: trata-se de um estudo retrospectivo descritivo, com componentes analíticos. Os dados foram analisados por meio das informações extraídas dos prontuários eletrônicos vinculados código do procedimento SUS entre 2019-2020. Resultados: nenhum dos 94 procedimentos culminou em complicações no dia de sua realização. Foram registradas complicações após sete dias do procedimento em apenas dois pacientes (2,13%). A radioscopia intraoperatória havia sido realizada em ambos os casos. Após 30 dias do procedimento, foram observadas complicações em dois pacientes entre os 92 restantes (2,17%), ambos submetidos ao implante do cateter sem tunelização. Não houve complicações seis meses após o implante do portocath em 57,4% dos pacientes e não há informação acerca dos outros 42,6%. Conclusão: a técnica inserção do portocath sem tunelização é um procedimento ambulatorial seguro, de baixo risco de complicação, podendo ser adotada como forma de abreviar tempo de procedimento e desconforto ao paciente, sem prejuízos funcionais ou de segurança. Não houve associação entre não tunelizar o cateter, lateralidade da veia puncionada e realização de radioscopia no transoperatório com a taxa de complicações.

Deglución post extubación de pacientes críticos con y sin diagnóstico de COVID-19 durante la pandemia / Post extubation swallowing in critical patients with and without COVID-19 during the pandemic

Estudios previos han caracterizado la disfagia en pacientes críticos hospitalizados que requieren intubación y ventilación mecánica invasiva. A raíz de la pandemia COVID-19 es necesario conocer las características deglutorias de pacientes diagnosticados con la enfermedad para su manejo. El objetivo de este estudio es analizar las características deglutorias de pacientes críticos extubados con y sin diagnóstico de COVID-19. Se llevó a cabo un estudio de cohorte retrospectivo con una muestra a conveniencia de 43 sujetos mayores de 15 años, ingresados al Hospital San Juan de Dios (Santiago, Chile) entre el 01 de junio y el 31 de agosto de 2020, intubados con o sin diagnóstico de COVID-19. Del total de sujetos, 22 padecieron de COVID-19 quienes estuvieron significativamente más días intubados que aquellos sin la patología (p=0,002). Inmediatamente posterior a la extubación orotraqueal, más del 90% de la muestra presentó disfagia. No hubo diferencia significativa en el nivel FILS ni asociación significativa en el grado de severidad de la disfagia entre sujetos con y sin COVID-19. Tampoco hubo diferencia significativa en el nivel FILS entre los grupos a los 10 días post-extubación. El nivel FILS a los 10 días aumentó significativamente en aquellos sujetos con COVID-19 (p=0,016) y sin COVID-19 (p=0,004). En la muestra, el nivel FILS y grado de severidad de la disfagia de los pacientes con y sin COVID-19 no mostraron diferencias estadísticas, siendo alto el porcentaje de disfagia en ambos grupos, lo que se podría asociar a la intubación orotraqueal y al tubo orotraqueal. Es necesaria la incorporación del fonoaudiólogo dentro de los equipos de Unidades de Pacientes Críticos para el manejo de los pacientes con COVID-19 y disfagia. Además, se recomienda continuar con más estudios en el área.

Previous research have described the deglutition disorders in critical hospitalised patients who required intubation and mechanical ventilation. In the pandemic context, it is mandatory to study both level and grade of dysphagia in patients suffering from COVID-19. The aim of this study is to analyse the deglutition features of extubated critical patients with and without COVID-19. A retrospective cohort study was performed, considering a convenience sample of 43 patients from 15 years old hospitalised at 'Hospital San Juan de Dios' between June 1st and August 31th 2020, who were intubated, with and without the diagnosis of COVID-19. 22of out 43 patients were diagnosed with COVID-19 who were intubated for significantly more days in comparison with those without COVID-19 (p=.002). After the intratracheal extubation, 90% of the sample was diagnosed with dysphagia. There was no significant difference in the FILS score nor significant association in dysphagia severity between patients with and without COVID-19. After 10 days post extubation, there was no significant difference in the FILS score between both groups. The FILS score increased significantly in the COVID-19 (p=.016) and non-COVID-19 (p=.004) patients after 10 days post extubation. Post extubation, there are no statistical differences in the FILS score and dysphagia severity in critical ill patients with and without COVID-19, with a high percentage of dysphagia in both groups which could be associated with intratracheal intubation and endotracheal tubes. The incorporation of speech and language therapists in Critical Care Units is mandatory. Furthermore, it is recommended to perform extra research in the area.

Predictive factors of mortality in damage control surgery for abdominal trauma / Fatores preditivos de mortalidade na cirurgia de controle de danos no trauma abdominal

ABSTRACT Introduction: damage control surgery (DCS) is well recognized as a surgical strategy for patients sustaining severe abdominal trauma. Literature suggests the indications, operative times, therapeutic procedures, laboratory parameters and intraoperative findings have a direct bearing on the outcomes. Objective: to analyze the clinical profile of patients undergoing DCS and determine predictors of morbidity and mortality. Methods: a retrospective cohort study was conducted on all patients undergoing DCS following abdominal trauma from November 2015 and December 2021. Data on subjects' demographics, baseline presentation, mechanism of injury, associated injuries, injury severity scores, laboratory parameters, operative details, postoperative complications, length of stay and mortality were assessed. A binary logistic regression analysis was performed to determine potential risk factors for mortality. Results: During the study period, 696 patients underwent trauma laparotomy. Of these, 8.9% (n=62) were DCS, with more than 80% due to penetrating mechanisms. Overall mortality was 59.6%. In the logistic regression stratified by survival, several variables were significantly associated with mortality, including hypotension, and altered mental status at admission, intraoperative cardiorespiratory arrest, need for resuscitative thoracotomy, metabolic acidosis, hyperlactatemia, coagulopathy, fibrinolysis, and severity of the trauma injury scores. Conclusion: DCS may be appropriate in critically injured patients; however, it remains associated with significant morbidity and high mortality, even at specialized trauma care centers. From pre and postoperative clinical and laboratory parameters, it was possible to predict the risk of death in the studied sample.

RESUMO Introdução: a cirurgia de controle de danos (CCD) é estratégia bem definida de manejo cirúrgico para pacientes vítimas de trauma grave. A literatura sugere que as indicações, tempo operatório, medidas terapêuticas adotadas, alterações laboratoriais e achados transoperatórios apresentam impacto direto sobre o desfecho. Objetivo: analisar o perfil clínico-demográfico dos pacientes submetidos à CCD e identificar fatores preditivos de morbimortalidade na amostra. Métodos: coorte retrospectiva a partir da análise de prontuários de pacientes submetidos à CCD por trauma abdominal entre novembro de 2015 e dezembro de 2021. As variáveis analisadas incluíram dados demográficos, tempo da admissão, mecanismo do trauma, lesões associadas, escores de trauma, parâmetros laboratoriais, achados cirúrgicos, reposição volêmica e de hemoderivados, complicações pós-operatórias, tempo de internação e mortalidade. Para analisar os fatores de risco para mortalidade, foi utilizada análise de regressão logística binária. Resultados: no período, foram realizadas 696 laparotomias por trauma abdominal e destas, 8.9% (n=62) foram CCD, sendo mais de 80% por mecanismo penetrante. A mortalidade foi de 59.6%. Na regressão logística estratificada pela sobrevida, diversas variáveis foram associadas à mortalidade com significância estatística, incluindo hipotensão e alteração do estado mental à admissão, parada cardiorrespiratória no transoperatório, necessidade de toracotomia de reanimação, acidose metabólica, hiperlactatemia, coagulopatia, fibrinólise, gravidade dos escores de trauma e necessidade de hemoderivados. Conclusão: apesar da condução da estratégia de CCD em centro de trauma, a morbimortalidade ainda é elevada. A partir de parâmetros clínicos e laboratoriais pré e pós-operatórios, é possível predizer o risco de evolução para óbito na amostra estudada.