Hematoma espontáneo de la vaina de los rectos en paciente con COVID-19 y leucemia mieloide crónica. Reporte de un caso clínico y revisión de la literatura

Introducción: El hematoma de la vaina de los rectos es poco frecuente. En este reporte se presenta un caso clínico de este cuadro en un paciente con neumonía por COVID-19 y leucemia mieloide crónica, junto con una revisión de literatura. Caso Clínico: Paciente masculino de 55 años, hospitalizado por neumonía por COVID-19 y leucemia mieloide crónica, presenta taquicardia, hipotensión y aumento de volumen abdominal asimétrico. En la tomografía computarizada se evidencia un hematoma de la vaina de los rectos. Se realiza drenaje quirúrgico y control del sangrado. No presentó complicaciones postoperatorias ni necesidad de reoperación. Discusión: Las complicaciones hemorrágicas en pacientes con COVID-19 están poco descritas. El sangrado es una posible complicación en pacientes con leucemia mieloide crónica. Es relevante tener en cuenta el hematoma de la vaina de los rectos en pacientes con COVID-19 y/o leucemia mieloide crónica que presenten aumento de volumen abdominal, para un manejo precoz por un equipo multidisciplinario. Conclusión: La vigilancia activa y el alto índice de sospecha son clave para identificar posibles complicaciones hemorrágicas en pacientes con COVID-19 y/o leucemia mieloide crónica.

Introduction: Rectus sheath hematoma is a rare entity. This report presents a clinical case of a rectus sheath hematoma in a patient with COVID-19 pneumonia and chronic myeloid leukemia, along with a review of the literature. Case Report: A 55-year-old male patient, hospitalized for COVID-19 pneumonia and chronic myeloid leukemia, presents with tachycardia and hypotension. Computed tomography shows a rectus sheath hematoma. Surgical management was performed to control bleeding and drainage of the hematoma. There were no postoperative complications or need for reoperation. Discussion: Hemorrhagic complications in patients with COVID-19 are seldomly reported. Bleeding is a possible complication in patients with chronic myeloid leukemia. It is important to take into account rectus sheath hematoma in patients with COVID-19 and/or chronic myeloid leukemia who present with abdominal pain, for early management by a multidisciplinary team. Conclusion: Active surveillance and a high index of suspicion are key to identifying potential bleeding complications in patients with COVID-19 and/or chronic myeloid leukemia.

Mechanical ventilation in SARS-CoV-2 patients: state of art / Ventilación mecánica en pacientes con SARS - CoV-2: estado del arte

Abstract CoVID-19-associated infection leads to a pathology of yet unknown clinical behavior, confronting the clinician with various challenges. An extensive search was conducted based on review articles on SARS-CoV-2 infection and studies including mechanical ventilation management strategies in order to complete this narrative review. Evidenced-based treatment for SARS-CoV2 infection is still in the works. We have some tools from our knowledge from past experiences indicating that a step-wise management approach should be used, without neglecting other joint therapeutic measures for improved clinical outcomes of a condition with a high mortality. The current recommendations indicate that patients with severe acute respiratory failure due to SARS-CoV-2 should be managed with protective mechanical ventilation measures. No strong evidence is yet available on the individualization of mechanical ventilation therapy according to phenotypes.

Resumen La infección asociada a COVID-19 produce una patología de comportamiento aún desconocido, planteándole diversos desafíos al clínico. Para esta revisión narrativa se llevó a cabo una extensa búsqueda basada en artículos de revisión sobre la infección por SARS-CoV-2 y estudios que incluían estrategias de manejo con ventilación mecánica. El tratamiento basado en evidencia para la infección por SARS-CoV2 todavía está en desarrollo. Tenemos algunas herramientas basadas en nuestros conocimientos de experiencias en el pasado que indican que se debe usar un abordaje escalonado, sin descuidar otras medidas terapéuticas conjuntas para mejorar los desenlaces clínicos de una condición con una elevada mortalidad. Las actuales recomendaciones indican que los pacientes con falla respiratoria aguda por SARS-CoV-2 deben manejarse con medidas de protección con ventilación mecánica. Aún no tenemos una sólida evidencia sobre la individualización del tratamiento con ventilación mecánica, de acuerdo a los distintos fenotipos.

Incertidumbre y afrontamiento en familiares de personas dependientes del alcohol: apoyo social y espiritualidad / Uncertainty and coping among relatives of alcohol dependent persons: social support and spirituality / Incerteza e enfrentamento em parentes de pessoas dependentes de álcool: apoio social e espiritualidade

Resumen Introducción: La dependencia al alcohol, considerada como una enfermedad crónica, es un detonante de incertidumbre para el familiar de la persona con dependencia, lo cual genera trastornos emocionales negativos. El apoyo social y la espiritualidad son mecanismos de afrontamiento que podrían disminuir la incertidumbre y favorecer el bienestar tanto físico, como psicológico. Objetivos: Determinar la relación y el efecto del apoyo social y la espiritualidad sobre la incertidumbre del familiar de la persona dependiente del alcohol. Métodos: Estudio descriptivo y correlacional, muestra de 135 mujeres pertenecientes a grupos Al-Anon, se utilizaron la Escala de Percepción de Incertidumbre en Padres y Miembros de la Familia (PPUS-FM) de Mishel, el cuestionario MOS-SSS de Sherbourne y Stewart y la Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Se identificó un coeficiente de correlación negativo y significativo de la incertidumbre con el apoyo social (r s= -.356, p <.01) y la espiritualidad (r s= -.216, p <.05). Mediante un modelo de regresión lineal general univariado se determinó que únicamente el apoyo social influye en la disminución de la incertidumbre (β= -.280, t= -3.62, p= .001) con un coeficiente de determinación o varianza explicada del 11.5%, mientras que la espiritualidad no mostró efecto (β= -.041, t= .218, p >.05) sobre la incertidumbre. Conclusiones: El apoyo social es identificado como un mecanismo de afrontamiento efectivo que permitirá al personal de enfermería desarrollar intervenciones dirigidas a reducir la incertidumbre en familiares de personas con algún tipo de dependencia.

Abstract Introduction: Alcohol dependency is a chronic illness which generates uncertainty and other emotional problems among the relatives of persons who suffer alcoholism. Social support and spirituality are some coping mechanisms which could reduce uncertainty and favor the physical and psychological wellbeing. Objective: To determine the relationship and the effect of social support and spirituality on the uncertainty experienced by relatives of alcohol dependent persons. Methods: This is a descriptive and correlational study. The sample was constituted by 135 women members of Al-Anon. The Mishel Scale of Perception of Uncertainty among Parents and Family Members (PPUS-FM), the Sherbourne and Stewart Questionnaire, and the Reed Spiritual Perspective Scale were all used. Results: Significant negative correlation coefficients between uncertainty and social support (r s= -.356, p .05). and spirituality (r s= -.216, p .05). were identified. Using a univariate general linear regression model, it was determined that only social supports reduced uncertainty (β= -.280, t= -3.62, p= .001) with 11.5% of variance explained; while spirituality did not produce any effect (β = -.041, t= .218, p >.05). Conclusions: Social support is identified as a coping mechanism which can be used by nursing staff to develop interventions aimed at reducing uncertainty among relatives of alcohol dependent persons.

Resumo Introdução: A dependência do álcool, considerada como uma doença crónica, é um gatilho de incerteza para o familiar da pessoa com dependência, o qual gera transtornos emocionais negativos. O suporte social e a espiritualidade são mecanismos de enfrentamento que poderiam diminuir a incerteza e favorecer o bem-estar tanto físico, quanto psicológico. Objetivos: Determinar a relação e o efeito do suporte social e a espiritualidade sobre a incerteza do familiar da pessoa dependente de álcool. Métodos: Estudo descritivo e correlacional, amostra de 135 mulheres pertencentes aos grupos Al-Anon, utilizaram-se a Escala de Percepção de Incerteza em Pais e Membros da Família (PPUS-FM) de Mishel, o questionário MOS-SSS de Sherbourne e Stewart e a Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Identificou-se um coeficiente de correlação negativo e significativo da incerteza com o apoio social (r s= -.356, p <.01) e a espiritualidade (r s= -.216, p <.05). Mediante um modelo de regressão linear geral univariado determinou-se que unicamente o apoio social influencia a diminuição da incerteza (β= -.280, t= -3.62, p= .001) com um coeficiente de determinação ou variância explicada do 11.5%, enquanto a espiritualidade não mostrou efeito (β= -.041, t= .218, p >.05) sobre a incerteza. Conclusões: O suporte social é identificado como um mecanismo de enfrentamento eficaz que permitirá ao pessoal de enfermagem desenvolver intervenções dirigidas a reduzir a incerteza em familiares de pessoas com algum tipo de dependência.

Ultrasonographic diagnosis of twins in two pregnant bitches: case report / Diagnóstico ultrassonográfico de gestação gemelar em duas cadelas: relato de caso

Multiple pregnancies in humans account for only 3% of pregnancies, 97-98% of which are twin pregnancies and the morbimortality is higher in the monochorionic twins when compared to dichorionic ones. The canine species is naturally multiparous, but the diagnosis of monochorionic twin pregnancy is not common. The objective of this report was to describe the ultrasonographic diagnosis of monochorionic twin pregnancies in two bitches [Pug (case 1) and Shih tzu (case 2)]. It was possible to verify the presence of one gestational vesicle containing two fetuses in each female by observing two heads or two bodies within the same placental site. These fetuses presented adequate viability and normal organogenesis. Their development was similar to the other fetuses. In case 1 they were stillborn and smaller than the other five live-born fetuses. The twins in case 2 were born alive, but they also appeared smaller when compared to the littermates. The gestational risks associated with this condition in pregnant bitches are still unknown, however, there are reports of fetal death in monochorionic pregnancies in this species. Therefore, ultrasonographic exam during pregnancy allows an early monochorionic diagnosis and monitoring the fetal viability could bring health benefits to both the female and the littermates.(AU)

As gestações múltiplas em humanos correspondem a apenas 3% das gestações, sendo 97-98% dessas gestações gemelares. Sabe-se que a morbimortalidade fetal é maior em gêmeos monocoriônicos do que nos dicoriônicos. A espécie canina é naturalmente multípara, mas o diagnóstico gestacional de gêmeos monocoriônicos não é comum. O objetivo deste relato é descrever o diagnóstico ultrassonográfico de gêmeos monocoriônicos em duas cadelas, sendo uma da raça Pug (caso 1) e outra da raça Shih-Tzu (caso 2). Foi possível verificar a presença de uma única vesícula gestacional contendo dois fetos em cada cadela, por meio da visibilização de duas cabeças ou de dois corpos dentro de uma mesma placenta. Esses fetos apresentavam viabilidade e organogênese adequadas e o grau de desenvolvimento era similar aos demais fetos da ninhada. No caso 1, os gêmeos nasceram mortos e de tamanho menor que os outros cinco fetos nascidos vivos. Os gêmeos do caso 2 nasceram vivos, mas também eram pequenos em relação aos irmãos da ninhada. Os riscos gestacionais associados a essa condição em cadelas ainda não são conhecidos, no entanto já existem relatos de morte fetal em gestação monocoriônica nessa espécie. Portanto, o exame ultrassonográfico durante a gestação permite um diagnóstico precoce da monocorionicidade, e a monitorização da viabilidade fetal pode trazer benefícios para a saúde da matriz, assim como para o restante da ninhada.(AU)

Dolor fantasma en niños y jóvenes amputados congénitos: prevalencia y características clínicas / Phantom pain in children and youth with congenital amputations: prevalence and clinical characteristics

Introducción: El dolor es una patología discapacitante, que en niños está siendo abordada en los últimos tiempos, siendo el dolor fantasma en amputados congénitos una complicación impensada hace algunos años, considerando teorías que describían que carecían de la madurez biológica suficiente para experimentarlo. Actualmente, existe literatura que reconoce una prevalencia de dolor fantasma de 3,7 a 20% en la población de amputados congénitos. Objetivo general: Evaluar población de amputados congénitos del Instituto Teletón Santiago para determinar incidencia, prevalencia lápsica y características clínicas del dolor fantasma. Pacientes y Métodos: Estudio descriptivo de prevalencia, con revisión de ficha clínica para registro de variables demográficas y clínicas, y aplicación de encuesta telefónica al total de pacientes que asintieran y contaran con el consentimiento de sus padres. Se incluyó a todos los pacientes de 10 o más años; se excluyó a los con hipoacusia asociada o con imposibilidad administrativa para contactarlos. Resultados: 57 pacientes, edad promedio 18,6 años, 59,6% con deficiencia longitudinal. Ningún paciente presentó dolor fantasma en el último mes en la población estudiada. La prevalecia lápsica fue de 7,0%. Un 24,6% refirió además presentar sensación fantasma alguna vez en su vida y un 5,3% haber presentado dolor en el último año. Conclusión: Existe dolor fantasma en la población de pacientes amputados congénitos en los rangos de prevalencia encontrados en la literatura internacional contribuyendo a la evidencia existente. Este es el primer estudio en nuestro país que evalúa dolor en deficiencias congénitas y constituye una línea de base para estudios adicionales.

Introduction: Pain is a crippling pathology, which has been addressed in children only in recent times, and phantom pain in congenital amputees was a complication unthought to exist some years ago, considering theories that described that they lacked biological maturity enough to experience it. Currently, there is literature that recognizes a prevalence of phantom pain of 3.7 to 20% in congenital amputees. Overall objective: To evaluate the in vivo amputee population of Instituto Teletón Santiago, to determine incidence, lapses prevalence and clinical characteristics of phantom pain in these patients. Patients and Methods: A prevalence descriptive study was carried out, with a review of the clinical files to register demographic and clinical variables and application of a telephone survey to the total number of Instituto Teletón Santiago patients who agreed to participate and had the consent of their parents. We included all patients aged 10 years and over; excluding those with associated hearing loss, or inability to contact for administrative reasons. Results: 57 patients, mean age 18,6 years, 59,6% with longitudinal deficiency. No patient refered phantom pain during de last month in the study population. The lapsic prevalence was 7,0%. 24,6% of the population studied reported phantom feeling at som time in their lives and 5,3% had phantom pain during the last year. Conclusion: There is phantom pain in the population of congenital amputees in the prevalence ranges found in the international literature contributing to the existing evidence. This is the first study in our country that evaluates pain in congenital deficiencies and constitutes a baseline for additional studies.

Objeción de conciencia y nuevo protocolo del Ministerio de Salud / Conscientious objection and new Ministry of Health protocol

The beginning of the implementation at the institutional level of Law 21.030, relating to the decriminalization of pregnancy for three reasons, has generated concerns, practical difficulties and changes in the dynamics of work teams in hospitals that have had to implementar. These difficulties refer to areas as varied as diagnosis, confirmation of the causes, to the opposition of different professionals in their participation in the process. In this first communication we will summarize the last of the problems arising from the new protocol issued by the Ministry of Health, regarding the Institutional Awareness Objection in Hospitals that, like the HCUCH, have an agreement with FONASA. (AU)

Hernia inguinal recidivada: tratamiento ambulatorio con anestesia local por la vía abierta anterior / Ambulatory repair of recurrent hernias: experience in 70 cases

Background: Recurrence is the most common long term complication of inguinal hernia repair. aim: To report the experience of ambulatory treatment of hernia recurrence. Patients and Methods: Seventy patients aged 56 +/- 14 years (59 men), with a low surgical risk and a body mass index below 40 kg/m² were admitted to the program. The surgical repair of the hernia was performed under local anesthesia on an ambulatory basis. All patients received antibiotic and prophylaxis for venous thrombosis. Results: The surgical procedure lasted 54 +/- 25 minutes. A tissue repair was performed in 12 cases and a prosthetic one in 48. The ductus deferens was accidentally sectioned in one case. The postoperative complications were one hematoma which did not require surgery and two superficial infections that healed in an ambulatory basis. A long term follow up, for 9.3 +/- 1.9 years after surgery was possible in 79 percent of cases. Two recurrences (3.5 percent) were observed and one patient complained of a light, intermittent pain in the inguinal region. There were two recurrences after tissue repair, both occurring after a Lichtenstein repair (4.2 percent). Ninety two percent of patients were satisfied or very satisfied with the procedure. Conclusion: Ambulatory treatment of recurrent hernias is feasible and safe.

Objetivos: La recidiva continúa siendo la más frecuente complicación tardía de las herniorrafias inguinales primarias; estas tasas son aún mayores cuando se actúa sobre las hernias recidivadas. En el presente estudio prospectivo, observacional, descriptivo, damos cuenta de nuestros resultados en una serie de pacientes intervenidos en forma electiva, en el Centro de Hernias del CRS Cordillera, entre los años 1998 y 2009 por hernias inguinales recidivadas. Material y Métodos: La cirugía se efectuó, con anestesia local asistida, en forma ambulatoria, tras una adecuada selección de los pacientes y firma de un consentimiento informado. Se intervinieron 70 pacientes, 59 varones y 11 mujeres con una edad promedio de 56,2 +/- 13,9 años. Se usó profilaxis antibiótica y de la trombosis venosa profunda. Resultados: La duración promedio de la cirugía fue de 54 +/- 25,3 min. Se efectuó reparación tisular en 12 y protésica en 48 casos. El conducto deferente se seccionó en forma accidental en un caso. En el postoperatorio hubo un hematoma y 2 infecciones superficiales que se trataron ambulatoriamente. El seguimiento alejado a un promedio de 9 (4-14) años se efectuó en el 79 por ciento de la serie, detectándose 2 recidivas (3,5 por ciento) y un caso de inguinodinia leve. Las 2 recurrencias se apreciaron en las reparaciones con técnica de Lichtenstein (4,2 por ciento). El 92 por ciento de los enfermos refirió estar satisfecho o muy satisfecho con el procedimiento. Conclusiones: La reparación ambulatoria con anestesia local, en manos expertas, es una alternativa a ser considerada en el tratamiento de las hernias inguinales recidivadas.

Relación entre burnout y engagement académicos con variables sociodemográficas y académicas / Relationship between burnout and academic engagement with sociodemographic variables and academic

Este estudio buscó esclarecer la interdependencia entre burnout académico (BA) y engagement académico (EA) en estudiantes universitarios del área de la salud, y profundizar en la caracterización de esta relación a partir de sus asociaciones con variables sociodemográficas y académicas (desempeño académico, DA). Se utilizó un diseño observacional y correlacional de tipo multivariado con una muestra, constituida aleatoria y estratificadamente por 802 estudiantes de los programas de medicina, enfermería, fisioterapia y psicología de universidades privadas de Barranquilla, Colombia. Los instrumentos utilizados fueron el MBI-SS, el UWES-S y un cuestionario sobre condiciones socioeconómicas y académicas. El análisis de las relaciones halladas entre BA y EA permitió considerarlos articulados como extremos de un mismo continuo fenoménico o factor, compuesto por las dimensiones de vigor, dedicación, ineficacia académica y cinismo, con valores opuestos en los extremos o polos del factor. Se identificaron variables sociodemográficas y académicas asociadas con los polos del BA y del EA del factor reconocido, donde el BA resultó un buen predictor de mal DA, y el EA un buen predictor de buen DA.

This study aims to clarify the interdependence between Academic Burnout (ab) and Academic Engagement (ae) in undergraduate students, and to describe this relationship based on their associations with demographic and academic variables (Academic Achievement - aa). A multivariate, correlational observational design was used, with a stratified random sample of 802 students from the programs of medicine, nursing, physiotherapy and psychology of private universities of Barranquilla, Colombia. The instruments used were the mbi-ss, the uwess and a questionnaire about academic and socioeconomic variables. The analysis of the relationship between ab and ae, suggests considering each of these syndromes as extremes of the same phenomenic continuum or factor, composed by the dimensions of Vigor, Dedication, Academic Inefficacy and Cynicism , with opposite values at the extremes or poles of the factor. Demographic and academic variables were associated with the poles of the ab and the ae of the acknowledged factor, where the ab was a good predictor of poor aa, and the ae a good predictor of good aa.

Dolor fantasma en niños y jóvenes amputados adquiridos: prevalencia y características clínicas / Phantom pain in children and teenagers with acquired amputations: prevalence an clinical features

Introducción: El dolor fantasma es una condición frecuente en pacientes amputados lo que genera discapacidad importante. En población adulta se estima una prevalencia entre 49-82 por ciento. Existe escasa evidencia de la incidencia y prevalencia en población de niños y adolescentes. Objetivos: Estimar la incidencia y la prevalencia del dolor fantasma en la población de amputados adquiridos del Instituto Teletón (IT) de Santiago de 10 años y más; caracterizar a esta población y asociar distintos factores clínicos y demográficos con la presencia de este dolor. Pacientes y Métodos: Estudio descriptivo de incidencia y prevalencia basado en la revisión de fichas clínicas para la obtención de datos demográficos, clínicos y evaluación de registro de dolor fantasma. Se aplicó encuesta telefónica a pacientes de 10 años o más, con diagnóstico de una o más amputación/es adquirida/s, que se atiendan o hayan sido atendido en IT Santiago hasta el año 2013. Resultados: La incidencia de dolor fantasma en la población estudiada es de 11 por 100 personas/año y prevalencia de 62 por ciento. Se encontraron asociaciones estadísticamente significativas, entre la presencia de dolor fantasma y el tiempo transcurrido desde la amputación (a mayor tiempo transcurrido, menor dolor) y edad de la amputación (a mayor edad en que se realizó la amputación mayor dolor). Conclusión: El dolor fantasma es un fenómeno frecuente en pacientes amputados adquiridos de 10 años y más atendidos en el IT de Santiago con una prevalencia del 62 por ciento.

Introduction: Phantom pain is a common condition in amputated patients generating significant disability. Prevalence among adult population is estimated at 49-82 percent. There is little evidence of the incidence and prevalence in child and adolescent population. Objectives: To estimate the incidence and prevalence of phantom pain in amputees aged 10 years and older of the Telethon Institute of Santiago; characterize this population and associate different clinical and demographic factors with the presence of phantom pain. Patients and Methods: Study incidence and prevalence based on a review of medical records to obtain demographic and clinical data. In addition a telephone survey was made to patients 10 years or older diagnosed with one or more acquired amputations who are treated or have been treated at Telethon Institute of Santiago until 2013. Results: The incidence of phantom pain in the study population is 11 per 100 persons/year and prevalence is 62 percent. Statistically significant associations were found between the presence of phantom pain variables and time since amputation (the longer the time elapsed, less pain) and age of amputation (the older the age at which major amputation was performed more pain). Conclusion: Phantom pain is a common phenomenon in patients with acquired amputation aged 10 years and older treated at the Telethon Institute of Santiago prevalence being 62 percent.

Caracterización sociodemográfica y clínica de la población atendida en el Instituto Teletón de Santiago / Sociodemographic and clinical characteristic of the population attended in the Instituto Teletón de Santiago

Los Institutos Teletón atienden al 85% de la población infantil chilena con discapacidad neuro-músculo-esquelética, concentrando el mayor porcentaje de esta población. Sin embargo, no existen registros que permitan caracterizar esta población. Objetivo: Caracterizar la población de pacientes atendidos en el Instituto Teletón de Santiago durante el año 2012. Pacientes y método: Se analizaron las características sociodemográficas de los registros electrónicos del Instituto Teletón de Santiago de los pacientes activos que se atendieron durante el año 2012. Resultados: Durante el año 2012 se atendió un total de 8.959 pacientes en el Instituto Teletón de Santiago. En relación con el nivel socioeconómico, un 33,3% de estos correspondieron a extrema pobreza, y un 28,7% a nivel medio bajo. Con respecto a los diagnósticos clínicos principales se encontró que la parálisis cerebral y otras encefalopatías que también llevan a discapacidad motora concentran el 55,4% de los casos. Conclusiones: Como producto de esta caracterización, sería adecuado fomentar la necesidad de optimizar el registro nacional de la población infantil con discapacidad y sus características particulares, para así poder tomar decisiones de políticas públicas, como destinación de fondos o programas de apoyo.

The Institutos Teletón care for 85% of the Chilean child population with neuromusculoskeletal disability, the large percentage concentrating in this population. However, there are no registers that enable a profile to be determined on this population. Objective: To determine the profile of patients attending the Instituto Teletón de Santiago during the year 2012. Patients and method: The sociodemographic characteristics were analyzed from the computerised records of the Instituto Teletón de Santiago on active patients who were seen during the year 2012. Results: A total of 8,959 patients were seen during the study year in the Instituto Teletón de Santiago. As regards socioeconomic level, 33.3% were in extreme poverty, 28.7% to low-middle level. The main clinical diagnoses were cerebral palsy and other encephalopathies that also lead to motor disability, and accounted for 55.4% of the cases. Conclusions: As a result of determining this profile, it would be appropriate to encourage the need for a national register of the child population with disability, as well as their particular characteristics in order to make decisions on public policy, as a destination for funds or support programs.

Síndrome de nariz vacía / Empty nose syndrome

El síndrome de nariz vacía es una enfermedad de reciente descripción, que no tiene una definición clínica clara. Se puede originar como complicación de la cirugía de resección de cornetes, en especial del inferior. La fisiopatología no está del todo definida, pero es probable que posterior a la resección de cornetes se altere la permeabilidad nasal, interfiriendo con los mecanismos neurosensitivos y con las funciones de los cornetes. Su síntoma principal, es la obstrucción nasal paradójica. El diagnóstico es clínico, basado en los síntomas con los hallazgos de una cavidad nasal amplia posterior a la cirugía nasal. El tratamiento es difícil por lo subjetivo de los síntomas, prefiriendo en un comienzo el tratamiento médico y reservando la cirugía para casos más severos. Lo más importante es la prevención, realizando cirugías lo más conservadora posibles de la anatomía de la cavidad nasal.

The Empty Nose Syndrome is a recently described disease, which has no clear clinical definition. It is a rare complication of turbinate surgery especially in the inferior turbinectomy. The pathophysiology is unclear, but after turbinectomy the nasal patency could be affected and this can interfere with neurosensory mechanisms and functions of the turbinates. The most common symptom is the paradoxical nasal obstruction. The diagnosis is clinical, based on symptoms with the discovery of a wide nasal cavity after nasal surgery. Treatment is difficult because of the subjective symptoms, initially preferring medical treatment and surgery is reserved for more severe cases. Most important is the prevention, being as conservative as possible with the nasal cavity.

Haematological and histopathological analysis in South American fish Piaractus mesopotamicus parasitized by monogenean (Dactylogyridae) / Análises hematológica e histopatológica no peixe sul-americano Piaractus mesopotamicus parasitado por Monogenea (Dactylogyridae)

Monogeneans are the parasites mostly found on the body surface and gills of fish and can cause large losses in farmed fish. Some studies demonstrate elevated parasitic levels causing hematological alterations. But few of them relate the effects of parasitism on the hematology and histopathology of native freshwater farmed fish. This study evaluated the host-parasite relationship in pacu (Piaractus mesopotamicus) parasitized by the monogenean Anacanthorus penilabiatus. Hematological and parasitological assessments were obtained in 60 fish captured in a fish farm located in Dourados, State of Mato Grosso do Sul, Central Brazil. Fish were analyzed in different categories of parasite number: class I (n=13; 0-200 parasites), class II (n=17; 201-1200 parasites); class III (n=7; 1201-2200 parasites); and class IV (n=23; more than 2200 parasites per host). The highest levels of parasitism caused significant decrease (p<0.05) in the hematocrit, red blood cells (RBC), mean hemoglobin concentration (MCHC) and basophils number. Thrombocytes, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), monocytes, eosinophils, neutrophils and LG-PAS did not present significant difference among the parasitic levels. In contrast, increased number of total leukocytes and lymphocytes were found in highly-parasitized fish. A positive linear correlation (p<0.01) was found between the amount of parasites and fish weight. Histopathology revealed severe hyperplasia, sub-epithelial edema, fusion of the secondary lamellae, focal and multifocal necrosis in highly parasitized fish.

Parasitos Monogenea são principalmente encontrados na superficie corporal e brânquias dos peixes, e podem acarretar grandes perdas em pisciculturas. Alguns estudos demonstram que elevados níveis de infestação parasitária podem alterar os parâmetros sanguíneos. Porém, poucos estudos se direcionam a esclarecer os efeitos do parasitismo sobre as características hematológicas em peixes nativos. Este estudo avaliou a relação parasito-hospedeiro em pacu (Piaractus mesopotamicus) parasitado pelo monogenético Anacanthorus penilabiatus. Avaliações hematológicas e parasitológicas foram obtidas de 60 peixes capturados de uma piscicultura localizada em Dourados, Estado de Mato Grosso do Sul (MS), Brasil Central. Os peixes foram divididos em diferentes categorias de número de parasitos: classe I (n=13; 0-200 parasitos), classe II (n=17; 201-1200 parasitos); classe III (n=7; 1201-2200 parasitos); e classe IV (n=23; mais que 2200 parasitos por hospedeiro). Os níveis mais elevados de parasitismo causaram diminuição significativa (p<0.05) no hematócrito, eritrócitos (RBC), concentração de hemoglobina corpuscular média (CHCM) e número de basófilos. Trombócitos, volume corpuscular médio (VCM), concentração de hemoglobina corpuscular media (CHCM), monócitos, eosinófilos, neutrófilos e LG-AS não apresentaram diferença significativa entre os níveis de parasitismo. Em contraste, o aumento do número de leucócitos totais e linfócitos foram encontrados em peixes altamente parasitados. Houve correlação linear positiva entre a quantidade de parasitos e o peso dos peixes. O exame histopatológico revelou severa hiperplasia, edema sub-epitelial, fusão das lamelas secundárias, necroses focal e multifocal em peixes altamente parasitados.

Propuesta de algoritmo terapéutico para hallux rigidus / Treatment algorithm proposed for hallux rigidus

El hallux rigidus es la artrosis más frecuente en el pie y tobillo y la segunda afectación más importante de la primera articulación metatarsofalángica tras el hallux valgus. Si no se trata, puede producir importantes alteraciones en la marcha, movilidad y actividades de la vida diaria. Pretendemos en este artículo de revisión presentar un algoritmo de tratamiento completo para todos los grados de esta enfermedad, tras una concienzuda revisión bibliográfica.

Hallux rigidus is the most frequent arthrosis of the foot and ankle and the second most important condition involving the first metatarsophalangeal joint after hallux valgus. If left untreated, it may cause important alterations in gait, mobility and activities of daily living. The purpose of this review article is to describe a complete treatment algorithm for all grades of this condition, after a thorough bibliographic review.

Helicometrina nimia Linton, 1910 (Digenea: Opecoelidae) in dusky grouper Epinephelus marginatus (Lowe, 1834) (Teleostei: Serranidae) from southeastern Brazil / Helicometrina nimia Linton, 1910 (Digenea: Opecoelidae) em garoupa verdadeira Epinephelus marginatus (Lowe, 1834) (Teleostei: Serranidae) no Sudeste do Brasil

Helicometrina nimia (Opecoelidae) is a digenean with wide distribution. Fish families most commonly used as hosts for H. nimia are Serranidae, Pomodasydae, Scorpaenidae and Clinidae. In the present study, a new host and a new host locality are presented for the species. A description of the studied specimens, besides comments concerning its taxonomic status and biometrically compared tables of H. nimia reports are given. The taxonomic status of members of Helicometrina has been questionable. The greatest controversy for the genus seems to be related to the validity of diagnostic features, especially in regard to the number of testes. In the present study, all studied specimens presented a permanent and steady number of testes (n=9) and therefore its use as a diagnostic character is supported by the present authors. Epinephelus marginatus is considered a new host for Helicometrina nimia, and São Paulo state, southeastern Brazil, a new locality for the species.

Helicometrina nimia (Opecoelidae) é um digenético com distribuição mundial. As famílias de peixes mais comumente utilizadas como hospedeiros por H. nimia são Serranidae, Pomodasydae, Scorpaenidae e Clinidae. No presente estudo, um novo hospedeiro e uma nova localidade são apresentados para a espécie. A descrição dos espécimes estudados, além de comentários sobre o seu status taxonômico e uma tabela comparativa de medidas de H. nimia são apresentados. O status taxonômico dos membros de Helicometrina tem sido questionável. A maior controvérsia dentro do gênero parece estar relacionada com a validade das características diagnósticas, especialmente no que diz respeito ao número de testículos. No presente estudo, todos os espécimes estudados apresentaram número permanente e estável de testículos (n=9) e, portanto, sua utilização como caráter diagnóstico é suportada pelos presentes autores. Epinephelus marginatus é considerada um novo hospedeiro para Helicometrina nimia e São Paulo, sudeste do Brasil, uma nova localidade para a espécie.

Helicometrina nimia / Helicometrina nimia

Helicometrina nimia (Opecoelidae) is a digenean with wide distribution. Fish families most commonly used as hosts for H. nimia are Serranidae, Pomodasydae, Scorpaenidae and Clinidae. In the present study, a new host and a new host locality are presented for the species. A description of the studied specimens, besides comments concerning its taxonomic status and biometrically compared tables of H. nimia reports are given. The taxonomic status of members of Helicometrina has been questionable. The greatest controversy for the genus seems to be related to the validity of diagnostic features, especially in regard to the number of testes. In the present study, all studied specimens presented a permanent and steady number of testes (n=9) and therefore its use as a diagnostic character is supported by the present authors. Epinephelus marginatus is considered a new host for Helicometrina nimia, and São Paulo state, southeastern Brazil, a new locality for the species.

Helicometrina nimia (Opecoelidae) é um digenético com distribuição mundial. As famílias de peixes mais comumente utilizadas como hospedeiros por H. nimia são Serranidae, Pomodasydae, Scorpaenidae e Clinidae. No presente estudo, um novo hospedeiro e uma nova localidade são apresentados para a espécie. A descrição dos espécimes estudados, além de comentários sobre o seu status taxonômico e uma tabela comparativa de medidas de H. nimia são apresentados. O status taxonômico dos membros de Helicometrina tem sido questionável. A maior controvérsia dentro do gênero parece estar relacionada com a validade das características diagnósticas, especialmente no que diz respeito ao número de testículos. No presente estudo, todos os espécimes estudados apresentaram número permanente e estável de testículos (n=9) e, portanto, sua utilização como caráter diagnóstico é suportada pelos presentes autores. Epinephelus marginatus é considerada um novo hospedeiro para Helicometrina nimia e São Paulo, sudeste do Brasil, uma nova localidade para a espécie.

VEGF receptor expression decreases during lung development in congenital diaphragmatic hernia induced by nitrofen

Changes in vascular endothelial growth factor (VEGF) in pulmonary vessels have been described in congenital diaphragmatic hernia (CDH) and may contribute to the development of pulmonary hypoplasia and hypertension; however, how the expression of VEGF receptors changes during fetal lung development in CDH is not understood. The aim of this study was to compare morphological evolution with expression of VEGF receptors, VEGFR1 (Flt-1) and VEGFR2 (Flk-1), in pseudoglandular, canalicular, and saccular stages of lung development in normal rat fetuses and in fetuses with CDH. Pregnant rats were divided into four groups (n=20 fetuses each) of four different gestational days (GD) 18.5, 19.5, 20.5, 21.5: external control (EC), exposed to olive oil (OO), exposed to 100 mg nitrofen, by gavage, without CDH (N-), and exposed to nitrofen with CDH (CDH) on GD 9.5 (term=22 days). The morphological variables studied were: body weight (BW), total lung weight (TLW), left lung weight, TLW/BW ratio, total lung volume, and left lung volume. The histometric variables studied were: left lung parenchymal area density and left lung parenchymal volume. VEGFR1 and VEGFR2 expression were determined by Western blotting. The data were analyzed using analysis of variance with the Tukey-Kramer post hoc test. CDH frequency was 37% (80/216). All the morphological and histometric variables were reduced in the N- and CDH groups compared with the controls, and reductions were more pronounced in the CDH group (P<0.05) and more evident on GD 20.5 and GD 21.5. Similar results were observed for VEGFR1 and VEGFR2 expression. We conclude that N- and CDH fetuses showed primary pulmonary hypoplasia, with a decrease in VEGFR1 and VEGFR2 expression.

Parâmetros ósseos de frangos de corte alimentados com rações contendo fitase e baixos níveis de fósforo disponível e proteína bruta / Bone parameters for broilers fed diets with phytase and low phosphorus and crude protein levels

Foram utilizados 504 pintos de linhagem comercial (Ag Ross 308) para frangos de corte de um dia de idade, distribuídos em 12 tratamentos com seis repetições. O delineamento experimental utilizado foi de blocos ao acaso em esquema fatorial 2x2x3, com dois níveis de fósforo disponível (0,45 e 0,34%), dois níveis de fitase (0 e 1200 FTU/kg) e três níveis de proteína bruta (22,5; 20,5 e 18,5%). A porcentagem de cálcio e fósforo nas tíbias foi influenciada significativamente pelos níveis de proteína e de fósforo na dieta com o uso da fitase. Os teores de matéria mineral nas tíbias apresentaram efeito linear com o uso da enzima e efeito quadrático com a ausência dela, apresentando maior valor com o nível de 22,5% de proteína na dieta. Já com os maiores níveis de fósforo houve efeito linear entre os níveis de proteína bruta na dieta e os pesos da matéria mineral nas tíbias, ou seja, quanto maior o nível de proteína, menor o peso da matéria mineral.

504 (five hundred four) 1 day old male chicks from a commercial broiler line (Ag Ross 308) were used, distributed in 12 treatments, with 6 replicates per treatment. The experimental design was casually blocked and treatments were organized in a 2x2x3 factorial arrangement: two available phosphorus levels (0.45 and 0.34%), two phytase inclusion levels (0 and 1200 FTU/kg) and three crude protein levels (22.5; 20.5 and 18.5%). Tibia calcium percentage was influenced by protein and phosphorus levels in the diet, when using phytase. Tibia ash levels showed a linear effect when enzymes were added and showed a quadractic effect without it, and the higher value was observed with 22.5% crude protein in the diet. With higher phosphorus levels a linear effect was observed between crude protein in the diet and tibia ash weights, as a higher protein level had lower tíbia ash weight.

Prematuridad y amputación: un futuro incierto / Prematury and amputation: an uncertain future

Premature birth can be associated to multiple complications in the new born. The amputation of an extremity is one of them. Even though it is a rare complication, it can have severe consequences, because it can overlap with the more frequent complications observed in prematurity and obstruct the evolution of the patient. The major cause of amputation in a premature infant is thrombosis, which is produced by the complication of a vascular access. There is a lack of articles describing the evolution of these patients beyond the acute event. We present a case of a patient that had an amputation related to prematurity and we detail how his rehabilitation process has been so far.

El parto prematuro conlleva a múltiples complicaciones en el recién nacido. La amputación de una extremidad es una de ellas. A pesar de ser una complicación poco frecuente, puede tener consecuencias graves, pues se puede sumar a las complicaciones más comunes de la prematurez y dificultar la evolución del paciente. La principal causa de amputación en un prematuro es la trombosis por complicación de un acceso vascular. No existen artículos que describan la evolución de estos pacientes más allá del evento agudo. Presentamos el caso de un paciente que sufrió una amputación producto de la prematurez y detallamos lo que ha sido hasta ahora su proceso de rehabilitación.