The luminescent Chalcones. Its potential use as a luminescent and antitumoral agents / Chalconas luminiscentes. Su uso potencial como agentes luminiscentes y antitumorales

Background: Hepatocellular carcinoma (HCC) is one of the most diagnosed cancers worldwide. Chemoprevention of HCC can be achieved using natural or synthetic compounds that reverse, suppress, detect, or prevent cancer progression. Objectives: In this study, both the antiproliferative effects and luminescent properties of 2'-hydroxychalcones were evaluated. Methods: Cell viability was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay, spectroscopy assays, and density functional theory (DFT) calculations were used to determine the luminescent properties of 2 ́-hydroxychalcones. Results: Cytotoxic effects of 2 ́-hydroxychalcones were observed over the HepG2 and EA.hy926 cells. Since the chalcone moiety could be used as a fluorescent probe, these compounds may be helpful in cancer diagnosis and tumor localization. They may enable tumor observation and regression through the fluorescence during treatment; therefore, the compounds are a potential candidate as novel anticancer agents acting on human hepatomas. Conclusions: This report describes the chalcones' use as a specific luminescent biomarker in tumor cells. We also report the cellular uptake of 2'-hydroxychalcones, their cellular distribution, and the mechanisms that may be responsible for their cytotoxic effects

ANTECEDENTES: El carcinoma hepatocelular (CHC) es uno de los cánceres más diagnosticados en todo el mundo. La quimio prevención del CHC se puede lograr utilizando compuestos naturales o sintéticos que reviertan, supriman, detecten o prevengan la progresión del cáncer. OBJETIVOS: En este estudio, se investigó tanto los efectos antiproliferativos como las propiedades luminiscentes de las 2'-hidroxicalconas. MÉTODOS: La viabilidad celular se evaluó usando el ensayo colorimétrico (MTT), los ensayos de espectroscopia y los cálculos DFT se usaron para determinar las propiedades luminiscentes de las 2 ́-hidroxichalconas. RESULTADOS: Se observaron efectos citotóxicos sobre las líneas celulares del tipo HepG2 y EA.hy926. Dado que la estructura de la 2 ́-hidroxichalcona puede ser usada como sonda fluorescente, estos compuestos pueden ser útiles en el diagnóstico del cáncer y la localización del tumor, ya que pueden permitir la observación a través de la fluorescencia y la regresión del tumor durante el tratamiento, por lo que son candidatas potenciales como nuevos agentes anticancerígenos que podrían actuar sobre hepatomas humanos. CONCLUSIONES: Este trabajo describe el uso de las 2 ́-hidroxichalconas como un biomarcador luminiscente específico para células tumorales. También informamos la captación celular de 2>-hidroxicalconas, su distribución celular y los mecanismos que pueden ser responsables de sus efectos citotóxicos

Cirugía de urgencia en pacientes con cáncer de colon complicado en Hospital Universitario "General Calixto García" / Emergency Surgery in Patients with Complicated Colon Cancer at General Calixto García University Hospital

Introducción: El cáncer de colon mantiene un importante impacto social y una alta morbilidad a pesar de programas de detección precoz existentes. Ocupa el cuarto lugar entre los tumores malignos y un número importante de pacientes son operados de urgencia por las complicaciones de esta enfermedad, muchas veces desconocida hasta el momento de la cirugía. Objetivo: Caracterizar la cirugía de urgencia realizada a los pacientes con diagnóstico de cáncer de colon complicado. Método: Se realizó un estudio observacional, descriptivo, de corte transversal entre enero de 2014 y diciembre de 2016, en el Servicio de Cirugía General. La muestra fue de 96 pacientes portadores de esta entidad en el Hospital Universitario "General Calixto García". Resultados: Se analizó la incidencia según sexo, relación sexo/localización, relación localización/complicación, estadificación y mortalidad. Prevalecieron los tumores de colon en el sexo femenino y por ende fueron más frecuente las pacientes con complicaciones quirúrgicas por esta entidad en nuestro centro. Predominó la localización derecha globalmente, con predominio femenino. La oclusión intestinal fue la complicación más frecuente. Sobresalió el estadio II según TNM con un 37,5 por ciento y una mortalidad postoperatoria del 31 por ciento. Conclusiones: Nuestros datos coinciden con la tendencia nacional sobre la mayor incidencia del cáncer de colon en pacientes femeninas, son estas las que mayor tasa de morbilidad y mortalidad reportan. Seguir perfeccionando el programa de prevención y detección temprana de la entidad y su tratamiento oportuno causará la reducción de los índices que hoy se exhiben(AU)

Introduction: Colon cancer still has an important social impact and high morbidity despite existing early detection programs. It ranks fourth among malignant tumors, while a significant number of patients undergo emergency surgery for complications of this disease, many times unknown until the time of surgery. Objective: To characterize the emergency surgery performed to patients with a diagnosis of complicated colon cancer. Method: An observational, descriptive, cross-sectional study was carried out, between January 2014 and December 2016, in the general surgery service. The sample consisted of 96 patients with this entity and from General Calixto García University Hospital. Results: The incidence was analyzed according to sex, sex/location relationship, location/complication relationship, staging and mortality. Colon tumors prevailed in the female sex and, therefore, patients with surgical complications from this entity were more frequent in our center. There right location predominated globally, with a predominance in the female sex. Intestinal obstruction was the most frequent complication. Stage two, according to the TNM classification, stood out, accounting for 37.5 percent, together with a postoperative mortality of 31 percent. Conclusions: Our data coincide with the national trend on the highest incidence of colon cancer in female patients, who account for the highest morbidity and mortality rates. Continuing to improve the entity's prevention and early detection program, as well as its timely treatment, will bring about a reduction in the rates nowadays reported(AU)

Síntomas inicialesen niños con maltrato infantil / Initial symptoms in children with child maltreatment

Introducción: Alrededor de 300 millones de niños y niñas en el mundo viven en situación de violencia, 70 millones de ellos en Latinoamérica, constituye uno de los problemas principales de salud pública en todo el mundo. Objetivo: Identificar los síntomas iniciales de niños con maltrato infantil atendidos en Sala de Primera Acogida del Hospital General Docente Ambato en el año 2017, para la obtención de un diagnóstico presuntivo. Métodos: Estudio retrospectivo, observacional, descriptivo, a través de entrevistas a los médicos que atendieron los niños maltratados y se realizó una observación científica. En una población de 437 niños atendidos en el año 2017, teniendo como muestra de estudio 50 pacientes elegidos por criterios de inclusión y exclusión. Resultados: Se obtuvo como resultado síntomas conductuales (95%), miedo (75%), depresión (65%), trastornos del sueño y alimentación (45%), como síntomas principales de un niño maltratado. Se elaboró una guía de detección y diagnóstico que facilite al personal de salud un diagnóstico temprano de maltrato infantil. Conclusiones: Los síntomas iniciales en niños maltratados demostraron afectación en el desenvolvimiento psicológico y físico normal del paciente menor de edad, en la que influyen varios factores del entorno social, familiar y los situacionales, en especial las variables cognitivas de las víctima que han permitido explicar la gravedad de la sintomatología, de la cual requiere un tratamiento, seguimiento adecuado y oportuno en un lapso de tiempo ideal

Introduction: Around 300 million children in the world live in a situation of violence, 70 million of them in Latin America, which constitutes one of the main problems of public health in the whole world. Objective: To identify the initial symptoms of children with child abuse treated in the First Reception Room of the Ambato General Teaching Hospital in 2017, in order to obtain a presumptive diagnosis. Methods: A retrospective study, observational, and descriptive, through interviews with the doctors who treated the abused children. In a population of 437 children attended in the year 2017, having as sample of study 50 patients chosen by inclusion and exclusion criteria. Results: Behavioral symptoms (95%), fear (75%), depression (65%), sleep disorders and feeding (45%) were the main symptoms of a battered child. A screening and diagnosis guide was developed to provide health personnel with an early diagnosis of child maltreatment. Conclusions: The initial symptoms in abused children showed affectation in the normal psychological and physical development of the minor patient, in which several factors of the social, familiar and situational environment influence, especially the cognitive variables of the victims that have allowed to explain the severity of the symptomatology, which requires treatment, adequate and timely follow-up in an ideal period of time.

Contaminación enteroparasitaria de moscas capturadas en el municipio Palavecino, estado Lara, Venezuela, 2017 / Enteroparasitary contamination of flies captured in the Palavecino Municipality, Lara State, Venezuela, 2017

Introducción: la falta de estudios en Venezuela que demostraran la importancia de moscas de interés médico como vectores mecánicos de enteroparásitos, motivó la realización de este trabajo descriptivo transversal, con muestra intencional, donde con trampas plásticas y ecológicas se capturaron adultos de moscas. Materiales y método: los ejemplares eran inactivados, para luego ser clasificadas por género, lavados con solución salina 0,85%, separados de la solución, y luego esta era centrifugada 10 minutos a 3.000 rpm, para posteriormente utilizar el pelet, el cual se montaba entre lámina y laminilla para observar el sedimento al microscopio. Resultados: se lograron capturar 1.061 adultos de moscas, los cuales correspondían taxonómicamente a los géneros: Phaenicia sp (29,2%), Blepharicnema splendens (6,4%), Cochliomyia hominivorax (3,8%), Musca domestica (3,4%), Sarcophaga sp; (3%), Cochliomyia macellaria (2,5%) y la sumatoria de otras especies (51,7%), tal que, de más de siete especies de moscas, se logró identificar los enteroparásitos Blastocystis sp, Endolimax nana, Entamoeba hartmanni, Entamoeba histolytica/dispar, Entamoeba coli, Iodamoeba butschlii, Pentatrichomonas sp (Trichomonas sp), mientras que los únicos helmintos conseguidos fueron las uncinarias (Anquilostomideos). Conclusiones: la contaminación enteroparasitaria de más de siete especies de moscas, con siete especies de enteroparásitos diagnosticados, resalta el papel transmisor de estos dípteros en el ciclo de los parásitos entéricos. (AU)

Introduction: the lack of studies in Venezuela that demonstrate the importance of flies of medical interest as mechanical vectors of enteroparasites, motivated the realization of this crosssectional descriptive work, with intentional sample, where with plastic and ecological traps, adults of flies were captured. Materials and methods: the specimens were inactivated, to be classified by gender, washed with 0.85% saline, separated from the solution and then centrifuged 10 min at 3000 rpm, to later use the pellet, which was mounted between lamina and lamella to observe the sediment under a microscope. Results: 1.061 adults of flies were captured, which corresponded taxonomically to the genera: Phaenicia sp (29,2%), Blepharicnema splendens (6,4%), Cochliomyia hominivorax (3,8%), Musca domestica (3,4), Sarcophaga sp; (3%), Cochliomyia macellaria (2,5%) and the sum of other species (51,7%), such that from more than seven species of flies were able to identify the enteroparasites: Blastocystis sp, Endolimax nana, Entamoeba hartmanni , Entamoeba histolytica/dispar, Entamoeba coli, Iodamoeba butschlii, Pentatrichomonas sp (Trichomonas sp), while the only helminths obtained were Uncinarias (Anquilostomideos). Conclusions: the enteroparasitic contamination of more than seven species of flies with seven species of enteroparasites diagnosed highlights the role of these dipterous transmitters in the cycle of enteric parasites.

Introdução: a falta de estudos demonstrando Venezuela voa a importância de interesse médico como vetores mecânicos enteroparasitas, conduziu à realização do presente trabalho descritiva em corte transversal, onde amostra intencional com plástico e armadilhas ecológicas, moscas adultas foram capturados. Materiais e métodos: as amostras foram inactivadas, e, em seguida, são classificados por género, lavada com 0,85% de solução salina, separado da solução e, em seguida, esta foi centrifugado 10 min a 3000 rpm, e, em seguida, usando o sedimento, que foi montado entre a lâmina e a lamela para observar o sedimento ao microscópio. Resultados: conseguiram capturar 1.061 moscas adultas, que taxonomicamente correspondiam aos géneros: Phaenicia sp (29,2%), Blepharicnemasplendens (6,4%), Cochliomyia hominivorax (3,8%), Musca domestica (3,4), Sarcophaga sp; (3%), Cochliomyia macellaria (2,5%) e a soma de outras espécies (51,7%), de modo que mais do que sete espécies de moscas podem ser identificados parasitas intestinais: Blastocystis sp, Endolimax nana, Entamoeba hartmanni histolytica / dispar Entamoeba, Entamoeba coli, Iodamoeba butschlii, Pentatrichomonas sp (Trichomonas sp), ao passo que apenas foram obtidos helmintos Uncinarias (Ancilóstomo). Conclusões: contaminação enteroparasitaria de mais de sete espécies de moscas com sete espécies de parasitas intestinais sublinha o papel destes transmissor Diptera no ciclo de parasitas entéricos diagnosticados.

Donantes de órganos en muerte cerebral por herida por proyectil de arma de fuego en cráneo: una trágica realidad que beneficia receptores de órganos en Colombia / Fire arm wounded cerebral death organ donors: a tragic reality that benefits organ receptors in Colombia

Antecedentes y objetivo. Los pacientes con muerte encefálica por trauma craneoencefálico secundario a herida por proyectil de arma de fuego ayudan a mitigar la necesidad de donantes de órganos y tejidos. En Colombia, el 78 % de los homicidios son por arma de fuego. Se buscaba describir la experiencia con donantes de órganos y tejidos con muerte encefálica secundaria a trauma craneoencefálico por herida por proyectil de arma de fuego en un centro colombiano de trasplantes. Materiales y métodos. Se trató de un estudio de cohorte histórica retrospectiva. Se caracterizaron 169 donantes con diagnóstico de muerte encefálica secundaria a trauma craneoencefálico por herida con proyectil de arma de fuego en la institución, entre 2010 y 2016. Las variables cualitativas se evaluaron mediante proporciones, las variables cuantitativas continuas, con medidas de tendencia central, y la supervivencia, con el método de Kaplan-Meier. Resultados. La mayoría de los pacientes eran de sexo masculino (93 %), con una mediana de edad de 21 años (rango intercuartílico, RIQ=17-27) y el 32 % tenía antecedentes de consumo de sustancias psicoactivas. El 12 % de los pacientes necesitó manejo con hemoderivados y el 62 % requirió dosis altas de vasopresores. Se trasplantaron 338 órganos sólidos. La supervivencia del injerto renal y hepático a un año fue de 90 % y 85 %, respectivamente, y a 5 años, de 87 % y 76 %. Conclusiones. Según este estudio, la mayoría de estos pacientes eran hombres jóvenes con órganos potencialmente trasplantables que mostraron excelentes resultados en la supervivencia de los injertos. Consideramos que estos donantes son una buena alternativa para aumentar el número de donantes de órganos y tejidos

Background and objectives: Patients with brain death (BD) due to traumatic brain injury (TBI) secondary to a gunshot (GS) wound in the skull contribute to mitigate the demand for organ and tissue donors. In Colombia, 78% of the homicides are by GS. We describe our experience with BD secondary to TBI by GS organ and tissue donors at a transplant center in Cali, Colombia. Materials and methods: This is a retrospective historical cohort study for characterization of donors diagnosed with BD secondary to TBI by GS at our institution in the period 2010-2016 (n=169). Qualitative variables were assessed by proportions, continuous quantitative variables with measures of central tendency, and survival with Kaplan Meier. Results: The majority of the patients were male (93%), with a median age of 21 years (RIQ 17-27), 32% had history of psychoactive substance use. 12% of the patient's required management with blood products and 62% with high doses of vasopressors. 338 solid organs were transplanted. Survival of the renal and hepatic graft at one year was 90% and 85% respectively and at five years of 87% and 76%. Conclusions: According to our study, the majority of these patients are young men with potentially transplantable organs, showing excellent results in the survival of the grafts. We consider these donors to be a good alternative to increase the number of organ and tissue donors

Células madre mesenquimales para la regeneración de tejidos: ¿Por qué siguen siendo una promesa sin cumplir? / Mesenchymal stem cells for tissue regeneration: ¿Why are they still an unfulfilled promise?

Desde su descripción inicial, hace ya más de 40 años, las células madre mesenquimales (MSC) fueron reconocidas como una importante alternativa para el manejo de enfermedades caracterizadas por la pérdida aguda o crónica de tejido, gracias a su capacidad de proliferación y diferenciación, lo cual les permitiría sustituir las células perdidas y de esta forma recuperar la estructura y función. Cada vez es más abundante la evidencia que sugiere el potencial de estas células para el manejo de un amplio grupo de enfermedades, al menos en modelos experimentales preclínicos. No obstante, esta capacidad no ha podido refrendarse contundente y consistentemente en ensayos clínicos. Con la presente revisión, se pretende presentar una visión del estado actual del desarrollo conceptual en torno a las capacidades terapéuticas de las MSC y un análisis crítico de algunos de los factores, que han impedido que estas sean una opción terapéutica usable en la práctica clínica diaria

Since they were initially identified more than 40 years ago, mesenchymal stem cells (MSCs) were recognized as an important therapeutic alternative for diseases characterized by acute or chronic loss of tissue, thanks to their proliferation and differentiation ability, which would allow the replacement of lost cells and their structural and functional recuperation. Evidence suggesting the therapeutic potential of these cells for a vast group of diseases increases day by day, at least in preclinical experimental models. However, clinical trials have been unable to obtain consistent and categorical results to demonstrate this capacity. This review aims to provide, an overview on the current status of the conceptual development on the therapeutic properties of MSCs, and a critical analysis of some factors which have hindered the application of this therapeutic option in daily clinical practice.

Analysis of contextual variables in the evaluation of child abuse in the pediatric emergency setting / Análise das variáveis contextuais na avaliação dos maus-tratos infantis a partir da realidade de uma urgência pediátrica

Abstract Objective: This article comprises a sample of abuse modalities observed in a pediatric emergency room of a public hospital in the Lisbon metropolitan area and a multifactorial characterization of physical and sexual violence. The objectives are: (1) to discuss the importance of social and family variables in the configuration of both types of violence; (2) to show how physical and sexual violence have subtypes and internal diversity. Methods: A statistical analysis was carried out in a database (1063 records of child abuse between 2004 and 2013). A form was applied to cases with suspected abuse, containing data on the child, family, abuse episode, abuser, medical history, and clinical observation. A factorial analysis of multiple correspondence was performed to identify patterns of association between social variables and physical and sexual violence, as well as their internal diversity. Results: The prevalence of abuse in this pediatric emergency room was 0.6%. Physical violence predominated (69.4%), followed by sexual violence (39.3%). Exploratory profiles of these types of violence were constructed. Regarding physical violence, the gender of the abuser was the first differentiating dimension; the victim's gender and age range were the second one. In the case of sexual violence, the age of the abuser and co-residence with him/her comprised the first dimension; the victim's age and gender comprised the second dimension. Conclusion: Patterns of association between victims, family contexts, and abusers were identified. It is necessary to alert clinicians about the importance of social variables in the multiple facets of child abuse.

Resumo Objetivo: Este artigo apresenta uma casuística de modalidades de maus-tratos numa urgência pediátrica (UP) de um hospital público na área metropolitana de Lisboa e uma caracterização multifatorial da violência física e violência sexual. Os objetivos são: 1) discutir a importância de variáveis sociais e familiares na configuração de ambos; 2) mostrar como violência física e violência sexual apresentam subtipos e diversidade interna. Métodos: Fez-se uma análise estatística de uma base de dados (1.063 registos de maus-tratos infantis, entre 2004-2013). Usou-se o formulário aplicado a casos com suspeita de maus-tratos, com dados sobre a criança, família, episódio de maus-tratos, agressor, história médica e observação clínica. Foi feita uma análise fatorial de correspondências múltiplas para identificar padrões de associação entre variáveis sociais e violência, física e sexual, bem como sua diversidade interna. Resultados: A prevalência de maus-tratos nessa UP foi de 0,6%. Predominam a violência física (69,4%) e a violência sexual (39,3%). Perfis exploratórios desses tipos foram construídos. Quanto à violência física, o sexo do agressor estrutura a primeira dimensão diferenciadora; sexo e grupo etário da vítima estruturam a segunda. No caso da violência sexual, a idade do agressor e corresidência com ele estruturam a primeira dimensão; idade e sexo das vítimas organizam a segunda dimensão. Conclusão: Identificaram-se padrões de associação entre vítimas, contextos familiares e agressores. É necessário alertar os clínicos para a importância das variáveis sociais nas múltiplas faces que os maus-tratos assumem.

Relaciones de pareja homosexual y heterosexual: un estudio comparativo

Esta investigación tiene el propósito de evaluar y comparar a personas heterosexuales y homosexuales, con relaciones de pareja estables, respecto a los componentes de la teoría triangular del amor, tácticas de resolución de conflictos, ajuste con la pareja y bienestar psicológico. Participaron 157 adultos jóvenes chilenos, 77 homosexuales (30 lesbianas y 47 gays) y 80 heterosexuales (45 mujeres y 35 hombres). Se utilizaron la Escala de Ajuste Diádico, la Escala Triangular del Amor de Sternberg, la Flourishing Scale de Diener y el Conflict Resolution Style Inventory de Kurdek. Los resultados muestran algunas diferencias significativas en tácticas de resolución de conflicto, componentes del amor y ajuste en la pareja, según la orientación sexual; además existen diferencias entre las mujeres que conviven y no conviven.

The aim of this study was to evaluate and compare heterosexual and homosexual people who are in stable relationships, with respect to the components of the triangular theory of love: conflict resolution tactics, couple adjustment and psychological wellbeing. The participants were comosed of 157 young adults Chileans: 77 homosexuals (30 lesbians and 47 gay men) and 80 heterosexuals (45 women and 35 men). The instruments used were the Dyadic Adjustment Scale, the Sternberg's Triangular Love Scale, the Flourishing Scale of Diener and Conflict Resolution Style Inventory of Kurdek. The results show that there are significant differences in some conflict resolution tactics, components of love between partners, and couple adjustment according to sexual orientation. In addition, there are also differences between women living and not living with a partner.

Resultados clínicos y ecocardiográficos a largo plazo de pacientes sometidos a valvuloplastia mitral percutanea / Long-term clinical and echocardiographic results of patients undergoing percutaneous mitral valvuloplasty

Resumen Antecedentes: la valvuloplastia mitral percutánea con balón (VMPB) es un tratamiento efectivo y recomendado para pacientes con estenosis mitral (EM) moderada o severa. Objetivos: describir las características epidemiológicas, clínicas y ecocardiográficas de pacientes con estenosis mitral sometidos a VMPB en el momento del procedimiento y hacerles seguimiento a 5, 10 y 15 años. Diseño: retrospectiva de una cohorte de pacientes con EM intervenidos con VMPB en la Clínica CardioVID; se analizan las características epidemiológicas, clínicas y ecocardiográficas antes, después del procedimiento y a largo plazo. Se define supervivencia libre de reintervención si durante el tiempo de seguimiento los pacientes no presentan nueva VMPB o cirugía de reemplazo valvular. Los procedimientos fallidos se definen como un área valvular mitral (AVM) pos VMPB<1.5cm2 o insuficiencia mitral>2+. Se define restenosis al tener AVM <1.5 cm2 con pérdida de 50% o más del área ganada con la VMPB. Resultados: se analizaron 162 VMPB realizadas desde enero de 1993 hasta diciembre de 2011. La ecocardiografía pos VMPB mostró que el AVM aumentó de 0.95±0.24cm2 a 1.56±0.33cm2 (p<0.001) medida por planimetría y 0.96±0.24 cm2 a 1.69±0.41 cm2 (p <0.0001) calculada por tiempo de hemipresión. El gradiente medio transvalvular disminuyó desde 14.1±5.7 mmHg a 6.9±3.4 mmHg (p <0.001). La supervivencia libre de reintervención fue 74% a cinco años, 53% a 10 años y 42% a 15 años. El tiempo mediano de supervivencia fue 128.8±26.4 meses (IC 95% 76.8-180.7); en pacientes con procedimiento fallido fue 57.2±6.1 meses y en el grupo de procedimiento exitoso fue 185.4±25.9 meses (p<0.001). Conclusiones: la VMPB es un procedimiento efectivo que produce un aumento significativo del área valvular mitral y retrasa de forma significativa la necesidad de cirugía de reemplazo valvular. EL AVM pos VMPB<1.5 cm2 fue el principal determinante negativo en el pronóstico a largo plazo.

Abstract Background: percutaneous mitral balloon valvuloplasty (PMBV) is an effective and recommended treatment for patients with moderate or severe mitral stenosis (MS). Objectives: to describe the epidemiological, clinical and echocardiographic characteristics of patients with mitral stenosis undergoing PMBV at the time of the procedure and to follow up at 5, 10 and 15 years. Design: retrospective review of a cohort of MS patients treated with PMBV at the CardioVID Clinic. The epidemiological, clinical and echocardiographic characteristics are analyzed before, after the procedure and in the long term. Reintervention-free survival is defined if during the follow-up period the patients do not undergo new PMBV or valve replacement surgery. Failed procedures are defined as a mitral valve area (MVA) pos PMBV <1.5cm2 or mitral insufficiency> 2+. Restenosis is defined as having MVA <1.5 cm2 with loss of 50% or more of the area gained with PMBV. Results: 162 PMBV realized from January 1993 to December 2011 were analized. Pos-PMBV echocardiography showed that MVA increased from 0.95 ± 0.24cm2 to 1.56 ± 0.33cm2 (p <0.001) as measured by planimetry and 0.96 ± 0.24 cm2 at 1.69 ± 0.41 cm 2 (p <0.0001) calculated by time of hemi pressure. The mean transvalvular gradient decreased from 14.1 ± 5.7 mmHg to 6.9 ± 3.4 mmHg (p <0.001). Survival free of reintervention was 74% at 5 years, 53% at 10 years and 42% at 15 years. Median survival time was 128.8 ± 26.4 months (95% CI 76.8-180.7); in patients with failed procedure was 57.2 ± 6.1 months and in the successful procedure group it was 185.4 ± 25.9 months (p <0.001). Conclusions: PMBV is an effective procedure that produces a significant increase in the mitral valve area and significantly delays the need for valve replacement surgery. The MVA pos PMBV <1.5 cm2 was the main negative determinant in the long-term prognosis.

Rabdomiólise como manifestação de uma doença metabólica: relato de caso / Rhabdomyolysis as a manifestation of a metabolic disease: a case report

RESUMO A rabdomiólise é um processo de destruição muscular com manifestações clínicas variáveis. Em pacientes pediátricos, tem como principal etiologia as doenças infecciosas. Apresentamos o caso de uma adolescente previamente saudável, que foi admitida ao nosso pronto-socorro com histórico de 4 dias com mialgia, fraqueza muscular e urina escura. Na avaliação inicial, apresentava-se desidratada. Os exames de sangue revelaram insuficiência renal aguda e aumento de enzimas musculares. A paciente foi transferida para nossa unidade de terapia intensiva pediátrica. Foi realizado tratamento clínico para correção da desidratação e das consequências iônicas e metabólicas da insuficiência renal. Em razão da oligúria, deu-se início à terapia de substituição renal. A investigação etiológica revelou um defeito da betaoxidação. Sabe-se que doenças metabólicas podem provocar rabdomiólise. A destruição muscular deve ser identificada precocemente, para evitar suas potenciais consequências. Em geral, o tratamento da rabdomiólise é conservador, embora em algumas situações seja necessária uma abordagem mais invasiva.

ABSTRACT Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifestations. In pediatric patients, its main etiology is infectious diseases. We present a previously healthy adolescent who was admitted to our emergency department with a four-day history of myalgia, muscle weakness and dark urine. At presentation, she was dehydrated. Blood analysis revealed acute renal failure and increased muscular enzymes. She was transferred to our pediatric intensive care unit. Medical therapies for correction of dehydration and the ionic and metabolic consequences of renal failure were performed. Due to oliguria, renal replacement therapy was initiated. An etiological investigation revealed a beta-oxidation defect. Metabolic diseases are a known cause of rhabdomyolysis. Muscular destruction should be diagnosed early in order to avoid its potential consequences. Generally, the treatment of rhabdomyolysis is conservative, although in some situations, a more invasive approach is needed.

Utilidad del uso de povidona yodada asociada a quimioprofilaxis en biopsia prostática transrectal / Efficacy of prophylactic povidone-iodine rectal cleansing in transrectal prostate biopsy

Introducción: La infección prostática y/o sistémica asociada a la Biopsia Prostática Transrectal (BPTR), es conocida y temida, por ser una complicación grave y potencialmente mortal. En el presente trabajo se analiza el impacto del uso de enema de Povidona Yodada Rectal en asociación a Quimioprofilaxis en la tasa de Infecciones Prostáticas y/o Sepsis secundaria.(AU)

Surgical treatment of osteonecrosis associated with bisphosphonates: a case report / Tratamento cirúrgico da osteonecrose associada a bisfosfonatos: relato de caso

Os bisfosfonatos (BFs) são rotineiramente usados no manejo de patologias ósseas e neoplasias malignas metastáticas, porém há um efeito adverso de seu uso crônico, denominado osteonecrose da mandíbula associada ao uso de bisfosfonatos (OMAB). O tratamento para OMAB é desafiador e complexo, pois ainda não há protocolos definitivos de tratamento e os inúmeros tratamentos descritos na literatura possuem índices variáveis de sucesso. Neste sentido, este estudo objetiva enfatizar a responsabilidade do cirurgião-dentista no conhecimento da OMAB e relatar um caso clínico em que o tratamento cirúrgico foi a melhor opção terapêutica. Paciente do sexo masculino, 69 anos de idade, procurou atendimento odontológico queixando-se de exposição óssea. Na anamnese, relatou fazer uso de BFs devido ao histórico de câncer. O exame intraoral revelou exposição óssea em região de molar inferior direito estendendo-se para região de trigonoretromolar pela face lingual. Fez-se o tratamento conservador com antibioticoterapia e bochechos com clorexidina a 0,12 %, porém não se obteve sucesso. Assim, optou-se pela remoção cirúrgica da área de necrose óssea e do dente envolvido. O pós-operatório ocorreu dentro dos padrões de normalidade. O conhecimento do cirurgiãodentista sobre esta patologia é essencial para prevenir, diagnosticar e tratar esta doença da forma mais adequada. Embora o tratamento de OMAB permaneça desafiador e complexo, o manejo cirúrgico é uma opção terapêutica para lesões em estágios clínicos iniciais e resistentes ao tratamento conservador, proporcionando um melhor prognóstico e qualidade de vida ao paciente. (AU)

Bisphosphonates (BP) are routinely used in the management of metastatic bone diseases and malignancies neoplasms, but there is an adverse effect of their chronic use called bisphosphonaterelated osteonecrosis of the jaw (BRONJ). Treatment for BRONJ is challenging and complex, as there is still no definitive treatment protocols and the various treatments described in the literature have success variables indexes. In this sense, this study aims to emphasize the responsibility of dentist about the knowledge of BRONJ and report a clinical case that the surgical therapy was the best treatment option. Male patient, sixty-nine years old, asked for dental care complaining about bone exposure. On the anamneses, he reported the use of BP due to cancer history. The intra oral examination revealed exposed bone in the lower right molar region extending to retromolar trigon region on lingual side. There was conservative treatment with antibiotic therapy and mouth rinses of chlorhexidine 0.12 %, but not obtaining success. Therefore, we opted for the surgical removal of necrotic bone area and the tooth involved. The postoperative was within normal standard. The knowledge of dentist about this pathology is essential to prevent, diagnose and treat this disease the most appropriate way. Although the treatment of BRONJ remains challenging and complex, surgical therapy is a treatment option for lesions in early clinical stages and resistant to conservative treatment, providing a better prognosis and quality of life for the patient. (AU)

Función longitudinal del ventrículo derecho estimada por el desplazamiento sistólico del anillo tricúspide (TAPSE) en 557 pacientes sano / Right ventricular longitudinal function assessed by tricuspid annular plane systolic excursion (TAPSE) in 557 healthy patients

Objetivo: determinar el valor de referencia del desplazamiento sistólico del anillo tricúspide (TAPSE) en una población de pacientes sin comorbilidades. Métodos: estudio descriptivo de pacientes adultos atendidos en un servicio de ecocardiografía, sin comorbilidades conocidas y con resultados normales de medidas bidimensionales, Doppler pulsado, continuo y tisular. Resultados: se analizaron 557 pacientes, con edad (± DE) 43,7±15 años, mujeres 63,5%, quienes tuvieron función sistólica ventricular izquierda conservada (fracción de expulsión 59,8±1% y diámetro telediastólico VI 2,6±0,2 cm/m2); no hubo evidencia de disfunción diastólica (onda e´ del anillo mitral 12 ± 3 cm/s) o hipertensión pulmonar (presión sistólica de la arteria pulmonar 23,8±6 mm Hg). El TAPSE promedio fue de 22,6±4 mm, sin diferencia significativa entre hombres (23,1±4 mm) y mujeres (22,4±3 mm). Tampoco hubo variaciones importantes en los resultados de acuerdo con el peso normal, el sobrepeso o la obesidad: 22,6±4 mm, 22,7±4 mm y 22,7±4 mm, respectivamente. Conclusión: en pacientes con un amplio rango de edad sin enfermedad cardiaca izquierda o derecha y sin hipertensión pulmonar, el valor del TAPSE osciló entre 22 mm y 23 mm, con un valor inferior de normalidad de 18 mm para la población evaluada.

Objective: to determine the reference value of tricuspid annular systolic displacement (TAPSE) in a population of patients without comorbidities. Methods: a descriptive study of adult patients attending an echocardiography service, with no known comorbidities and with normal two-dimensional and Doppler measurements (pulsed continuous and tissue Doppler). Results: we analyzed 557 patients. Mean age was (± SD) 43.7 ± 15 years. 63.5% were women. All had preserved left ventricular systolic function (ejection fraction 59.8 ± 1% and 2.6 VI diastolic diameter ± 0.2 cm/m2). There was no evidence of diastolic dysfunction (wave e 'of the mitral annulus 12 ± 3 cm / s) or pulmonary hypertension (systolic pulmonary artery pressure 23.8 ± 6 mm Hg). The average TAPSE was 22.6 ± 4 mm, with no significant difference between men (23.1 ± 4 mm) and women (22.4 ± 3 mm). No significant variations were found in the results according to normal weight, overweight or obesity: 22.6 ± 4 mm, 22.7 mm and 22.7 ± 4 ± 4 mm, respectively. Conclusion: in patients with a wide range of age without left or right heart disease, and without pulmonary hypertension, the value of TAPSE ranged between 22 mm and 23 mm, with a lower normal limit value of 18 mm for the population studied.

Análise epidemiológica de fraturas bucomaxilofaciais em pacientes atendidos no Hospital Universitário de Santa Maria-Husm: um estudo retrospectivo / Epidemiological analysis of maxillofacial fractures in patients treated at University Hospital of Santa Maria-HUSM: a retrospective study

Este é um estudo retrospectivo do período de janeiro de 2005 a dezembro de 2007 para verificar aspectos epidemiológicos de fraturas bucomaxilofaciais em pacientes atendidos no Hospital Universitário de Santa Maria-HUSM. Tem como objetivo traçar o perfil epidemiológico quanto ao gênero, idade, localização da fratura, fator etiológico e tratamento dos pacientes atendidos no referido hospital no período de dois anos, por meio de análise de prontuários. Os dados coletados receberam como tratamento estatístico o Teste Exato de Fisher. Foram avaliados 479 prontuários, dos quais 166 eram referentes à fratura e se enquadravam nos quesitos de inclusão do estudo. Observou-se que o gênero mais afetado por fraturas bucomaxilofaciais foi o masculino com 83,3% e que a faixa etária mais acometida foi de 21 a 25 anos (15,66%). A média de idade para o gênero feminino foi de 40 anos e para o gênero masculino 31 anos. O fator etiológico mais observado foi agressão física (24,70%) seguido por acidente de motocicleta (12,05%), acidente de carro (8,43%) e atropelamento (5,42%). Os ossos nasais (31,33%) foram os que mais sofreram fraturas, seguido pelo complexo zigomático (30,72%), mandíbula (28,31%) e maxila (4,22%). Os pacientes pesquisados foram na sua maioria tratados por procedimento cirúrgico (43,37%) seguido de tratamento conservador (27,71%).

This is a retrospective study of the prevalence of buco maxillofacial fractures in patients seen at the University Hospital of Santa Maria, from January 2005 to December 2007, in Santa Maria, Brazil. The aim is to trace the epidemiological profile with regards to gender, age, site of fracture, aetiological factor and method of treatment of the patients seen at the hospital at issue, during the period of three years. A total of 479 records were evaluated, of which 166 presented fractures and fitted the criteria for enrolment in the study. It was observed that the gender most affected by buco maxillofacial fractures was male (83.3%) and most of the patients were in the age range of 21-25 years (15.66%). The most common aetiological factor was assault (24.7%), followed by motorbike accident (12.05%), car accident (8.43%) and pedestrian hit by vehicle (5.42%). The nasal bones (31.33%) were the most frequent site of fracture, followed by zygoma (30.72%), mandible (28.31%) and maxilla (4.22%). The majority of the evaluated patients were treated by surgical procedure (43.37), followed by conservative treatment (27.71%).

Alças esterilizáveis para refletor odontológico / Handles sterilizable to dental reflector

Pesquisas demonstram um aumento no índice de doenças infectocontagiosas que podemser adquiridas através da infecção cruzada, como os vírus da Hepatite B, Herpes, HIV,entre outros, além de bactérias e fungos. Diante da ameaça constante desses micro-organismos patogênicos, o controle da infecção tem sido uma fonte de preocupação aosCDs. Dessa forma, investir na produção de uma alça de refletor esterilizável contribuirápara o controle de infecção, protegendo e ajudando o profissional preocupado com a suasaúde e as de seus pacientes. O objetivo do estudo foi verificar junto aos fabricantes deequipamentos odontológicos no Brasil, quais disponibilizam a alça esterilizável para orefletor e se este acessório elevaria o custo final do equipamento. Foram consultadas seisfábricas de equipamentos odontológicos do Brasil através de um questionário compreendendoinformações sobre a existência, importância, custo e interesse dos fabricantesna comercialização de um dispositivo para aumentar a praticidade na manutenção dabiossegurança nos procedimentos cirúrgicos odontológicos. Apenas uma das fábricasentrevistadas disponibiliza o acessório autoclavável para a alça do refletor. As demaisempresas demonstraram interesse e consideram relevante o uso do mesmo, mas não ooferecem aos profissionais.

Researches shows an increase in the infectious diseases rate that can be acquired throughcross-infection such as Hepatitis B, Herpes, HIV, among others, besides bacteria andfungi. Facing the constant threat of these pathogens microorganisms, infection controlhas been a source of concern to dentists. Thus, to invest in the production of a reflectorsterilizable handle will contribute to the infection control, protecting and assisting thedentist worried with its health and the health of their patients. The aim of this studywas to check with the manufacturer of dental equipment in Brazil, who provide thesterilizable handle for the reflector and if its production will increase the final cost of theequipment. We interviewed six dental equipment factories in Brazil through a questionnairecontaining information about the existence, importance, cost and manufacturersinterest in the commercialization of a device to increase convenience to maintenance ofbiosecurity in dental surgical procedures. Only one of the interviewed factories providesthe autoclavable accessory to the reflector handle. The other factories showed interestand considered relevant the use of this accessory, but do not offers to the professionalto commercialize.

Perfil clínico, epidemiológico y quirúrgico de pacientes operados por cáncer renal en el Hospital Naval Almirante Nef / Clinical, epidemiological and surgical profile of renal cancer patients at Hospital Naval Almirante Nef

Introducción: El cáncer renal ocupa el tercer lugar dentro de los tumores genitourinarios y el 3 por ciento de los tumores malignos primarios, siendo el cáncer urológico con mayor mortalidad y cuya incidencia ha aumentado a nivel mundial. Material y método: Revisión retrospectiva de las fichas de todos los pacientes con diagnóstico de cáncer renal que fueron nefrectomizados o tumorectomizados entre los años 1999 y 2009 en el Hospital Naval Almirante Nef de Viña del Mar, con un total de 135 pacientes. Resultados: Observamos un aumento importante en el número de casos el año 2009, siendo más frecuente en hombres durante los diez años revisados. La media de la edad fue de 61,81 años y la mayoría no presentaba factores de riesgo. Cuarenta y ocho por ciento de los casos diagnosticados fueron hallazgos y 60 por ciento de éstos se encontraban en etapa I. El síntoma más frecuente fue el dolor abdominal. Setenta por ciento de los casos fueron diagnosticados por ecotomografía abdominal y 12 por ciento por pielotac. El 11 por ciento de los pacientes presentaron metástasis posquirúrgicas, siendo la mayoría a pulmón seguido de hígado. De éstos, 20 por ciento habían presentado tumores primarios menores de 7 cm. Conclusión: La incidencia del cáncer renal va en aumento y el diagnóstico precoz de lesiones asintomáticas y de bajo volumen que presentan un porcentaje no despreciable de infiltración tumoral, sugieren un manejo quirúrgico agresivo.

Introduction: Renal cancer represents the third most common cancer within genitourinary tumors and3 percent of all primary malignant tumors. It is the urological cancer with the most mortality rate and it´s incidence has increased worldwide. Methods: Restrospective review of the medical records of every patient diagnosed with renal cancer who where nephrectomized or tumorectomized between the years 1999 and 2009 at Hospital Naval Almirante Nef, Viña del Mar, with a total of 135 patients. Results: There was an important increase in the number of cases in 2009. The higher frequency in men was maintained during the years studied. The mean age was 61.81 years and most of the patients didn’t have any risk factors. 40 percent of the diagnosed cases were asymptomatic findings and 60 percent of them where on stage I. The most frequent symptom was abdominal pain. 70 percent of all cases where diagnosed by abdominal ecotomography and 12 percent CT without contrast. 11 percent of the patients presented post-surgical metastasis, most of them to lung followed by liver. 20 percent of them had primary tumors smaller than 7 cm. Conclusion: The incidence of renal cancer is increasing and the early diagnosis of asymptomatic and small lesions which in an important percentage have tumoral infiltration suggest an aggressive surgical treatment.