Revisión del intervalo de referencia del recuento plaquetario: ¿son adecuados los valores que estamos utilizando? / Review of the platelet count reference range: are the values we are using appropriate?

Los intervalos de referencia (IR) dependen de la población y de las características metrológicas del procedimiento de medida utilizado. A pesar de las recomendaciones internacionales, son pocos los laboratorios que establecen sus propios IR para cada magnitud por la dificultad para conseguir voluntarios de referencia y el elevado costo económico asociado. La International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) acepta la adopción de IR bibliográficos o su cálculo por métodos indirectos dado su bajo costo y fácil obtención. Existen varias fuentes confiables de IR bibliográficos para el hemograma. No obstante, para el recuento plaquetario, es una práctica común de los laboratorios emplear el rango de valores de 150-450.109 /L independiente de la metodología utilizada y grupo etario. El objetivo de este trabajo fue revisar los IR bibliográficos disponibles para el recuento plaquetario y estimarlo empleando el método indirecto de Hoffmann a partir de nuestra población. Los métodos indirectos se basan en aplicar criterios de exclusión y cálculos matemáticos sobre los resultados de una base de datos de laboratorio. Nuestros IR para el recuento plaquetario se comparan con los bibliográficos, que han sido establecidos por técnicas de muestreo directo. Por este motivo y dado que no existen estudios poblacionales que lo avalen, sería apropiado reemplazar el rango de 150-450.109 / L. Estos límites podrían seguir empleándose como puntos de corte o niveles de decisión médica para definir, según la clínica y otros resultados de laboratorio, los pacientes que ameritan un seguimiento posterior (AU)

Reference ranges (RR) depend on the population and the metrological characteristics of the measurement procedure used. Despite international recommendations, few laboratories establish their own RRs for each magnitude because of the difficulty in obtaining reference volunteers and the associated high economic cost. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) accepts the use of literaturebased RRs or RRs calculated by indirect methods because of their low cost and easy collection. There are several reliable sources of literature-based RRs for the Cell Blood Count. However, for platelet count, it is common laboratory practice to use the range of 150-450,109 /L regardless of the methodology used and age group. The aim of this study was to review the available literature regarding RRs for platelet count and to establish it using the indirect Hoffmann method in our population. Indirect methods are based on applying exclusion criteria and mathematical calculations on the results of a laboratory database. Our RRs for platelet counts are compared with those in the literature, which have been established by direct sampling techniques. Therefore, and given that there are no population studies to support these findings, it would be appropriate to replace the 150-450,109 /L range. These limits may continue to be used as cut-off points or medical decision levels to define, according to clinical manifestations and other laboratory results, patients who warrant further follow-up (AU)

Cáncer de vesícula en colecistectomías de la región de Tarapacá. Análisis según pertenencia étnica / Prevalence of gallbladder cancer in a Northern Chilean region

BACKGROUND: Gallbladder Cancer (GBC) prevalence varies among countries, associated with different geographical and genetic factors. The Mapuche ethnicity (Ethnia mostly located between the VIII and X Chilean regions) stands out in Chile due to its high GBC prevalence. Aim: To estimate the GBC prevalence in patients undergoing cholecystectomy at a public hospital in the Northern region of Chile (Tarapaca), where other ethnical groups are common. MATERIAL AND METHODS: Pathological reports of 3270 patients (72% women) who underwent cholecystectomy between January 2016 and December 2019 were revised. Subsequently, the accreditation of ethnic belonging for each patient to one of the ten native communities in Chile was requested to the National Corporation for Native Communities Development (CONADI). RESULTS: According to the analysis of pathological reports, the global GBC prevalence was 0.3 %. The prevalence in Aymaras was 0.4% and 0% in Mapuches. The distribution of ethnic origins among analyzed patients was Aymara in 14.3, Mapuche in 2.7%, Diaguita in 1.7%, Quechua in 1.3%, Atacameña in 0.2%, and Colla in 0.2%. No specific ethnic origin was found in 79% of patients. Conclusions: There was a low GBC prevalence rate in Northern Chile and among the Aymara population.

Resultados funcionales de un programa de recuperación rápida comparado con el protocolo habitual en artroplastía total de rodilla / Functional results of a rapid recovery program compared to the usual protocol in total knee arthroplasty

Resumen: Introducción: Los programas de recuperación rápida en cirugía de reemplazo articular son eficaces en países desarrollados; el objetivo de este estudio fue evaluar los resultados funcionales de un programa de recuperación rápida en nuestra población y comprarlos con los resultados del protocolo habitual. Material y métodos: Se realizó un ensayo clínico no ciego simple aleatorizado con pacientes candidatos a artroplastía total de rodilla (n = 51) reclutados de Mayo de 2018 a Diciembre de 2019. El grupo A (n = 24) recibió un programa de recuperación rápida y el grupo B (n = 27) recibió el protocolo habitual, con seguimiento durante 12 meses. Para el análisis estadístico se utilizó la prueba de t de Student (variables continuas paramétricas), Kruskal-Wallis (variables continuas no paramétricas) y la prueba de χ2 (variables categóricas). Resultados: Se encontraron diferencias estadísticamente significativas entre grupos en el dolor a los dos meses (grupo A 3.4 ± 1.3 versus grupo B 4.2 ± 1.4, p = 0.04) y seis meses (1 ± 0.8 versus 1.7 ± 1.2, p = 0.01), con el cuestionario WOMAC a los dos meses (grupo A 74.5 ± 7.2 versus grupo B 67.2 ± 7.5, p ≤ 0.01), seis meses (88.7 ± 5.3 versus 83.0 ± 4.8, p ≤ 0.01) y 12 meses (90.1 ± 4.5 versus 86.7 ± 4.3, p ≤ 0.01) y con el cuestionario IDKC a los dos meses (grupo A 62.9 ± 7.0 versus grupo B 55.9 ± 6.1, p ≤ 0.01), seis meses (74.3 ± 2.7 versus 71.1 ± 3.9, p ≤ 0.01) y 12 meses (75.4 ± 3.0 versus 72.6 ± 3.5, p ≤ 0.01). Conclusiones: Los resultados obtenidos en este estudio sugieren que la implementación de estos programas puede ser una alternativa segura y eficaz en cuanto a la disminución del dolor y a la capacidad funcional en nuestra población.

Abstract: Introduction: Rapid recovery programs in joint replacement surgery are effective in developed countries; The objective of this study was to evaluate the functional outcomes of a rapid recovery program in our population and to compare them with the results of the usual protocol. Material and methods: A randomized single blinded clinical trial was conducted with patients who were candidates for total knee arthroplasty (n = 51) recruited from May 2018 to December 2019. group A (n = 24) received a rapid recovery program and group B (n = 27) received the usual protocol, with follow-up for 12 months. For statistical analysis, the Student's t test (parametric continuous variables), Kruskal-Wallis (nonparametric continuous variables) and the chi-square test (categorical variables) were used. Results: Statistically significant differences were found between groups in pain at two months (group A 3.4 ± 1.3 vs group B 4.2 ± 1.4, p = 0.04) and six months (1 ± 0.8 vs 1.7 ± 1.2, p = 0.01), with the WOMAC questionnaire at two months (group A 74.5 ± 7.2 vs group B 67.2 ± 7.5, p ≤ 0.01), six months (88.7 ± 5.3 vs 83.0 ± 4.8, p ≤ 0.01) and 12 months (90.1 ± 4.5 vs 86.7 ± 4.3, p ≤ 0.01), and with the IDKC questionnaire at two months (group A 62.9 ± 7.0 vs group B 55.9 ± 6.1, p ≤ 0.01), six months (74.3 ± 2.7 vs 71.1 ± 3.9, p ≤ 0.01) and 12 months (75.4 ± 3.0 vs 72.6 ± 3.5, p ≤ 0.01). Conclusions: The results obtained in this study suggest that the implementation of these programs can be a safe and effective alternative in terms of reducing pain and functional capacity in our population.

Moringa Oleifera: an alternative ingredient to improve the egg quality of Japanese quail / [Moringa oleifera: um ingrediente alternativo na melhora da qualidade de ovos de codornas japonesas]

This study aims to evaluate effects of inclusion of moringa in Japanese quail diets on laying performance, egg quality, blood parameters, serum biochemical profile, and behavior. One hundred and forty-four Japanese quails, approximately 35-d-old, were distributed in a completely randomized design with four treatments and six replications. Treatments were diet inclusion of 0, 2, 4 and 6% of dried and ground moringa leaves. The inclusion of moringa in diets reduces the quadratic feed intake up to the level of 1.20%, increases weight of eggs with a quadratic behavior up to 3.80%, and linearly increases yolk weight. Yolk color changes with higher levels of inclusion of moringa and resulted in more intense colors. The biochemical profile of quails changed slightly but remains within the normal range. The inclusion of 4% of moringa in diets increases alkaline phosphatase. Regarding cholesterol and triglycerides, diet with 6% moringa inclusion was lower when compared to the others. The behavior of laying quails does not change due to inclusion of moringa in diets. Up to 3.83% of Moringa oleifera can be included in Japanese quail diet to improve egg quality without compromising performance, biochemical profile, blood parameters and behavior.(AU)

O objetivo deste estudo foi avaliar a inclusão de Moringa oleifera na dieta de codornas japonesas sobre o desempenho, a qualidade de ovos, os parâmetros sanguíneos, o perfil bioquímico e o comportamento. Foram utilizadas 144 codornas japonesas, com aproximadamente 35 dias de idade, as quais foram distribuídas em delineamento inteiramente ao acaso, com quatro tratamentos e seis repetições cada. Foram fornecidas dietas com 0, 2, 4 e 6% de folhas desidratadas e moídas de moringa. A inclusão de moringa nas dietas reduziu quadraticamente o consumo até o nível de 1,2%, aumentou o peso dos ovos com comportamento quadrático até o nível de 3,8% e aumentou linearmente o peso da gema. A coloração da gema se intensificou com maiores inclusões de moringa. O perfil bioquímico sofreu alterações leves, mas não saiu dos padrões normais para codornas. A inclusão de 4% de moringa nas dietas aumentou os níveis de fosfatase alcalina. Já a inclusão de 6% reduziu níveis de colesterol e triglicérides. O comportamento das codornas não se alterou com a inclusão de moringa nas dietas. A inclusão de até 3,83% de Moringa oleifera na dieta de codornas japonesas aumenta a qualidade de ovos sem comprometer o desempenho, o perfil bioquímico, os parâmetros sanguíneos e o comportamento delas.(AU)

Antifungal susceptibility profile of Candida clinical isolates from 22 hospitals of São Paulo State, Brazil

This study aimed to evaluate the frequency of cryptic Candida species from candidemia cases in 22 public hospitals in São Paulo State, Brazil, and their antifungal susceptibility profiles. During 2017 and 2018, 144 isolates were molecularly identified as 14 species; C. parapsilosis (32.6%), C. albicans (27.7%), C. tropicalis (14.6%), C. glabrata (9.7%), C. krusei (2.8%), C. orthopsilosis (2.8%), C. haemulonii var. vulnera (2.1%), C. haemulonii (1.4%), C. metapsilosis (1.4%), C. dubliniensis (1.4%), C. guilliermondii (1.4%), C. duobushaemulonii (0.7%), C. kefyr (0.7%), and C. pelliculosa (0.7%). Poor susceptibility to fluconazole was identified in 6.4% of C. parapsilosis isolates (0.12 to >64 µg/mL), 50% of C. guilliermondii (64 µg/mL), 66.6% of C. haemulonii var. vulnera (16-32 µg/mL), and C. duobushaemulonii strain (MIC 64 µg/mL). Our results corroborated the emergence of C. glabrata in Brazilian cases of candidemia as previously reported. Importantly, we observed a large proportion of non-wild type C. glabrata isolates to voriconazole (28.6%; <0.015 to 4 µg/mL) all of which were also resistant to fluconazole (28.6%). Of note, C. haemulonii, a multidrug resistant species, has emerged in the Southeast region of Brazil. Our findings suggested a possible epidemiologic change in the region with an increase in fluconazole-resistant species causing candidemia. We stress the relevance of routine accurate identification to properly manage therapy and monitor epidemiologic trends.

On-farm welfare assessment in dairy goats in the Brazilian Northeast / [Avaliação do bem-estar de cabras leiteiras em fazendas no nordeste brasileiro]

The objective of this study was to apply a modified AWIN Goat protocol to evaluate and compare the welfare of adult lactating and non-lactating dairy goats at pen and individual levels on small farms located in Ceará, Northeast, Brazil, and to take into consideration the application of this protocol on Brazilian Northeast goat farms. Five farms with Lactating goats (L) and five farms with non-lactating goats (NL) were evaluated. At the first level of welfare assessment, animals were evaluated in the pen and during the second level of welfare assessment, animals were evaluated in the pen and individually. Indicators assessed were animal and resource-based indicators. Significant difference between L and NL on farms was set at P<0.05. Only queuing at feeding indicator showed significant difference (P=0.027) between groups in pens at the first level welfare assessment. On individual assessments, there was significant difference between L and NL regarding body condition score (P=0.003), overgrown claws (P=0.001) and udder asymmetry (P=0.001). The application of a modified AWIN Goat protocol on farms in Ceará was considered positive. In general, these results demonstrated that both groups are submitted to welfare problems in Ceará, although lactating goats present more challenges to cope.(AU)

O objetivo deste estudo foi aplicar o protocolo AWIN de Cabras modificado para avaliar e comparar o bem-estar de cabras adultas lactantes e não lactantes em termos de baia e individualmente, em pequenas propriedades localizadas no Ceará, nordeste, Brasil, e levar em consideração a aplicação desse protocolo em fazendas caprinas do nordeste brasileiro. Cinco fazendas com cabras lactantes (L) e cinco fazendas com cabras não lactantes (NL) foram avaliadas. No primeiro nível de bem-estar, os animais foram avaliados nas baias e, durante o segundo nível de bem-estar, os animais foram avaliados na baia e individualmente. Os indicadores avaliados foram baseados em animais e recursos. Diferença significativa entre L e NL nas fazendas foi estabelecida em P<0,05. Apenas o indicador na fila na alimentação mostrou diferença significativa (P=0,027) entre os grupos na baia no primeiro nível de bem-estar. Nas avaliações individuais, houve diferença significativa entre L e NL com relação ao escore de condição corporal (P=0,003), sobrecrescimento das unhas (P=0,001) e assimetria do úbere (P=0,001). A aplicação do protocolo AWIN de cabras modificado em fazendas no Ceará foi considerada positiva. De modo geral, esses resultados demonstraram que ambos os grupos estão submetidos a problemas de bem-estar no Ceará, embora cabras em lactação apresentem mais desafios para enfrentar.(AU)

Prevalencia de colecistolitiasis y cáncer de vesícula en una población rural aymara de Chile

Background: The prevalence of cholelithiasis and gallbladder cancer may be different across ethnic groups. Aim: To study the prevalence of cholelithiasis and gallbladder cancer among Aymara individuals. Material and Methods: An abdominal ultrasound was carried out in a sample of 182 Aymara women aged 46 ± 16 years and 76 Aymara men aged 55 ± 16 years. In addition, the histopathological reports of both patients with a history of previous cholecystectomy and those operated after the study were reviewed. Results: Ultrasound was normal in 150 participants (58%), 76 had cholelithiasis (30%) and 32 (12%) had a history of cholecystectomy. Pathological reports of the excised gallbladder were available for 106 cases and showed a chronic cholecystitis in 98% of cases. Gallbladder cancer was not reported. Conclusions: There is a 42% prevalence of cholelithiasis and no gallbladder cancer in this sample of Aymara population.

Tumor glómico en mucosa bucal: reporte de caso / Tumor in oral mucosa: case report

El tumor glómico es una neoplasia vascular originada de las células del músculo liso del componente neuromioarterial, responsable del control del flujo sanguíneo microvascular. Representa el 1,6% de todos los tumores de tejidos blandos, localizándose principalmente en la zona subungüeal y clínicamente muy doloroso. Su diagnóstico puede ser tardío debido a su pequeño tamaño, manifestaciones clínicas inespecíficas y localizaciones anatómicas inusuales. El tratamiento principalmente es quirúrgico, el cual es curativo, permitiendo además la confirmación histopatológica. Se presenta el reporte de caso de una paciente de 13 años de edad con un tumor glómico de localización inusual en mucosa bucal.

The glomus tumor is a vascular neoplasm originating from smooth muscle cells of neuromyoarterial component, responsible for the control of microvascular blood flow. It represents 1.6% of all soft tissue tumors, being located mainly in the subungual area and clinically very painful. Diagnosis may be delayed because of their small size, nonspecific clinical manifestations and unusual anatomical locations. Treatment is primarily surgical, which is healing, also allowing the histopathologic confirmation. The case report of a 13-year-old patient with an unusual-located glomus tumor in the oral mucosa is presented.

Bem-estar dos cães de abrigos municipais no estado do Paraná, Brasil, segundo o protocolo Shelter Quality / The welfare of dogs from municipal shelters in the state of Paraná, Brazil, under the Shelter Quality protocol

O bem-estar dos animais, além dos aspectos individuais, depende do entendimento e dedicação dos responsáveis pelo abrigo. O objetivo do presente trabalho foi avaliar o bem-estar dos cães mantidos em abrigos municipais do estado do Paraná, mediante a aplicação do protocolo Shelter Quality. Foram avaliados 16 abrigos, 439 cães e 165 recintos, na estação do outono de 2017. A maioria dos abrigos apresentou cães com condição corporal adequada e pelagem limpa, em recintos seguros, com metragem e suprimento de água adequados e conforto térmico. Além disso, a maioria dos cães eram mantidos em recintos coletivos e em ambientes abertos, com baixo nível de ruído e demonstravam mais emoções positivas, desejáveis na adoção. Como aspectos negativos, 58% (96/165) dos recintos avaliados tinham camas inadequadas ou inexistentes e 30% (50/165) dos recintos mantinham cães individualmente, sendo indicadores de baixo grau de bem-estar para os cães envolvidos. Além disso, nenhum abrigo disponibilizava ração para cães idosos e 81% (13/16) dos abrigos negligenciavam o diagnóstico e tratamento da dor. Apesar de a maioria dos abrigos apresentarem mais pontos positivos que negativos em sua avaliação, a gestão dos abrigos deve sempre visar à correção dos pontos críticos que comprometam o bem-estar dos animais.(AU)

Animal welfare, in addition to individual aspects, depends on the understanding and dedication of those responsible for the shelter. The objective of this study was to evaluate the welfare of dogs kept in municipal shelters in the state of Paraná, using the Shelter Quality protocol. A total of 16 shelters, 439 dogs and 165 enclosures were evaluated in the fall season of 2017. Most shelters presented dogs with adequate body condition and clean coat, in secure enclosures with adequate water supply and thermal comfort. In addition, most dogs were kept in collective enclosures and in open environments, with low noise levels and showing more positive, desirable emotions in adoption. As negative aspects, 58% (96/165) of the precincts evaluated had inadequate or inexistent beds and 30% (50/165) of the enclosures kept dogs individually, being indicators of a low degree of well-being for the dogs involved. In addition, no shelter provided elderly dog rations and 81% (13/16) of the shelters neglected the diagnosis and treatment of pain. Although most shelters present more positive than negative points in their evaluation, shelter management should always aim at correcting critical points that compromise animal welfare.(AU)

Percepción del clima social en el aula por estudiantes de enfermería de tres facultades españolas / Perception of the classroom social climate by nursing students in three Spanish Universities / Percepção do clima social na aula por estudantes de enfermagem de três faculdades espanholas

Resumen Introducción: El clima social en el ámbito académico es la percepción que tienen los individuos de los distintos aspectos del ambiente en el que se desarrollan. Contar con un clima social positivo facilita el rendimiento del alumnado y su satisfacción personal. Objetivo: Analizar la relación del sexo, la edad o el centro universitario con la percepción del clima social en el aula en estudiantes del 2º curso del Grado en Enfermería de las Facultades de Burgos, Soria y Valladolid, España. Métodos: Estudio descriptivo correlacional, cuya población de estudio fueron todos los estudiantes matriculados en el 2º curso del Grado en Enfermería en las Facultades de Burgos, Soria y Valladolid durante el periodo académico 2017/2018; se estudia la posible relación entre el clima social en el aula y los factores sociodemográficos mediante análisis bivariado. Resultados: Aceptaron participar 172 estudiantes. Se observó que tener más edad se relacionaba con una mayor motivación para asistir a clase (p=0.009), con un sentimiento de orgullo ante la universidad (p=0.001), con una mayor colaboración entre compañeros (p=0. 038) o con un mayor conocimiento de las normas de la universidad (p=0.001). Conclusiones: El clima social en los centros analizados se sitúa en un nivel intermedio, es irrelevante el sexo y el centro universitario. El alumnado de mayor edad se presenta más motivado por el estudio, más colaborador y más identificado con el centro.

Abstract Introduction: Academic social climate is the perception which individuals have regarding the diverse aspects of the environment in which they are academically developing. Having a positive social climate facilitates the performance and personal satisfaction among students. Objective: To analyze the relationships between sex, age, and university with the perception of classroom social climate among students of the 2nd Grade of Nursing in the Universities of Burgos, Soria, and Valladolid, Spain. Methods: This is a descriptive and correlational study. The population was constituted by all the students enrolled at the 2nd Grade of Nursing in the Universities of Burgos, Soria, and Valladolid during the 2017/2018 academic period. Using bi-variate analysis, the possible associations between classroom social climate and sociodemographic factors were studied. Results: A total of 172 students agreed to participate. It was observed that being older was associated to having a higher motivation to attend classes (p=0.009), a higher feeling of pride towards the university (p=0.001), a greater collaboration among colleagues (p=0.038), or a better knowledge of the university norms (p=0.001). Conclusions: Perceived social climate in these universities turn out to be fair. Sex and the specific university center were not particularly associated to the students' social climate perception. The older students tended to be more motivated and collaborative, and more identified with the university.

Resumo Introdução: O clima social no âmbito acadêmico é a percepção que têm os indivíduos dos distintos aspectos do ambiente no qual se desenvolvem. Contar com um clima social positivo facilita o rendimento do alunado e sua satisfação pessoal. Objetivo: Analisar a relação do sexo, a idade ou o centro universitário com a percepção do clima social na aula em estudantes do 2º curso de Grau em Enfermagem das Faculdades de Burgos, Soria e Valladolid, Espanha. Métodos: Estudo descritivo correlacional, cuja população de estudo, foram todos os estudantes matriculados no 2º curso de Grau em Enfermagem nas Faculdades de Burgos, Soria e Valladolid durante o período acadêmico 2017/2018; estuda-se a possível relação entre o clima social na aula e os fatores sociodemográficos mediante análise bivariada. Resultados: Aceitaram participar 172 estudantes. Observou-se que ter mais idade relacionava-se com uma maior motivação para assistir à aula (p=0.009), com um sentimento de orgulho ante a universidade (p=0.001), com uma maior colaboração entre companheiros (p=0. 038) ou com um maior conhecimento das normas da universidade (p=0.001). Conclusões: O clima social nos centros analisados situa-se em um nível intermediário, é irrelevante o sexo e o centro universitário. O alunado de maior idade apresenta-se mais motivado pelo estudo, mais colaborador e mais identificado com o centro.

Hallazgos de videofluoroscopía en niños de 3 a 6 años con parálisis cerebral / Videofluoroscopic findings in children from 3 to 6 years old with cerebral palsy

Introducción: Los trastornos de la alimentación y deglución (TAD) acompañan frecuentemente a la parálisis cerebral (PC). Su diagnóstico oportuno previene numerosas complicaciones. La evaluación clínica es el primer acercamiento a los TAD, pero resulta insuficiente para identificar situaciones de riesgo (penetración laríngea o aspiración). Para ello, es necesaria una evaluación instrumental como la videofluoroscopía (VFC). Objetivo: Describir y cuantificar los hallazgos de VFC en un grupo de niños con PC, entre 3 años y 6 años 11 meses, GMFCS I-V. Pacientes y Métodos: Se practicó una VFC a 50 pacientes con PC, previa determinación del nivel Gross Motor Functional Classification System (GMFCS) e inexistencia de contraindicaciones para dicho examen. Además, se determinaron signos de incompetencia e inseguridad deglutoria, consistencias toleradas y requerimientos de posicionamiento, para facilitar el procedimiento. Resultados: Población predominantemente masculina, edad promedio de 5 años, 78% GMFCS III-V. Hasta el 94% tuvo una o más alteraciones videofluoroscópicas en alguna etapa del examen. El 28% no presentó capacidad de masticación, siendo todos GMFCS V. En eficacia deglutoria la alteración más frecuente fue el residuo vallecular (86%). En seguridad deglutoria fue el derrame posterior en la fase oral (68%). El 26% tuvo aspiración traqueal silente. En la fase esofágica, el 30% presentó tránsito esofágico lento y el 8% reflujo gastroesofágico. Conclusión: La VFC identificó alteraciones potencialmente riesgosas en todos los niveles GMFCS en niños portadores de PC, algunas de ellas silentes, incluso en casos de compromiso motor leve.

Introduction: Cerebral palsy (CP) is frequently accompanied by feeding and swallowing disorders (FSD). An early diagnosis of FSD prevents numerous complications. Clinical assessment stands as the first approach to FSD, although it is insufficient to identify risk factors (laryngeal penetration and aspiration). For this purpose, a videofluoroscopic (VFC) evaluation is required. Objective: To describe and quantify VFC findings in a group of children with CP, aged 3 to 6 years, GMFCS I to V. Patients and Methods: 50 patients underwent a VFC after their Gross Motor Functional Classification System (GMFCS) level was determined and no contraindications for the exam were identified. In addition, the researchers conducted an assessment to establish the presence of signs of unsafe and incompetent swallowing, food consistency tolerance, and mealtime positioning requirements, in order to allow a more comfortable VFC procedure. Results: There was male predominance, average age of 5 years, 78% GMFCS III-V. Up to 94% had one or more VFC alterations at some point of the exam. 28% had no chewing ability, being all the cases GMFCS V. Considering the deglutition efficacy, the commonest alteration was residue in the vallecula (86%), while the most frequent for swallowing safety was posterior spillage in the oral phase (68%). 26% presented silent tracheal aspiration. In the esophageal phase the findings were poor esophageal transit (30%) and gastroesophageal reflux (8%). Conclusions: VFC identified potentially risks in every GMFCS level of children with CP. Some of the VFC alterations are silent, even in mild motor impairment cases.

Reconstrucción de los ligamentos coracoclaviculares con injerto tendinoso autólogo de peroneo lateral corto / Coracoclavicular ligaments reconstruction with short lateral peroneal autologous tendon graft

Resumen: Introducción: En la luxación acromioclavicular inestable verticalmente es elemental el tratamiento quirúrgico mediante la reconstrucción de los ligamentos coracoclaviculares, con la finalidad de recuperar su estabilidad y función normal. Existen técnicas de un solo túnel o de dos en la clavícula (anatómica) con material biológico o sintético. Material y métodos: Es un estudio cuasiexperimental prospectivo longitudinal; se incluyeron 33 pacientes entre 20 y 50 años de edad con diagnóstico de luxación acromioclavicular completa con inestabilidad vertical. Se les efectuó plastía sólo de los ligamentos coracoclaviculares con técnica anatómica de Mazzocca usando injerto tendinoso autólogo del peroneo lateral corto. La evaluación de resultados fue con el test de PENN. Resultados: 100% de los pacientes se encuentran sin dolor y con un arco de movilidad normal del hombro un año después de la cirugía. Radiográficamente, la distancia coracoclavicular comparada con el lado sano tuvo una diferencia promedio de 1.0 mm en reposo y 0.9 mm bajo carga. Discusión: La plastía tendinosa de los ligamentos coracoclaviculares con técnica anatómica mediante injerto tendinoso autólogo del peroneo lateral corto permite recuperar la estabilidad acromioclavicular y la función normal del hombro a 12 meses de seguimiento.

Abstract: Introduction: In the dislocation acromioclavicular unstable vertically, the surgical treatment is elementary by the plasty of the ligaments coracoclaviculares, with the purpose of recovering its stability and normal function. There are techniques of a single tunnel in the clavicle or two tunnels (anatomical), with biological or synthetic material. Material and methods: It is a longitudinal prospective experimental study; we included 33 patients between 20 and 50 years of age with diagnosis of complete acromioclavicular dislocation with vertical instability. Reconstruction was performed only of the coracoclavicular ligaments with Mazzoca's technique of using autologous tendon graft of the short lateral peroneus. The evaluation of results was with the PENN test. Results: 100% of patients are painless and with an arch of normal shoulder mobility one year after surgery. Radiographically, the coracoclavicular distance compared to the healthy side had an average difference of 1.0 mm at rest and 0.9 mm under load. Discussion: The reconstruction of the coracoclavicular ligaments with anatomical technique by autologous tendon graft of the short lateral peroneus, allows to recover the acromioclavicular stability and the normal function of the shoulder.

Características relevantes das instalações e da gestão de abrigos públicos de animais no estado do Paraná, Brasil, para o bem-estar animal / Relevant characteristics of facilities and management of public animal shelters in the state of paraná, Brazil, for animal welfare

Animais podem ser eventualmente recolhidos em abrigos públicos no Brasil e o ambiente de alojamento afeta diretamente sua qualidade de vida. Este trabalho estudou características relevantes das instalações físicas e da gestão dos estabelecimentos vinculados ao poder público municipal que abrigam cães, gatos e cavalos no estado do Paraná. Foram registrados 17 municípios com 20 abrigos, dos quais 18 participaram da pesquisa. Todos os municípios mantinham cães, sete (41,2%) mantinham gatos e oito (47,1%) mantinham cavalos. Todos os abrigos apresentavam recintos coletivos; dois (11,8%) de cães e cinco (71,5%) de gatos mantinham um animal por recinto; quatro (22,2%) mantinham recintos sem visualização além do próprio recinto; 11 (64,7%) realizavam limpeza adequadamente; cinco (29,4%) abrigos de cães e um (14,3%) de gatos não tinham área para quarentena ou isolamento sanitário; camas estavam disponíveis em 15 (88,2%), cinco (71,4%) e um (12,5%) dos recintos de cães, gatos e cavalos, respectivamente. Os abrigos de animais no Paraná devem banir recintos de isolamento social, incluir uma cama por animal e socializar os animais. Adicionalmente, há oportunidade de aumentar o grau de bem-estar animal por meio de melhorias no manejo dos animais e no manejo sanitário, as quais não dependem de reformas nas instalações.(AU)

Animals may be eventually collected by public shelters in Brazil and the shelter's environment directly affects their quality of life. This work studied relevant characteristics of the physical facilities and the management of establishments liked to the municipal public power that shelter dogs, cats and horses in the state of Paraná. It was registered 17 municipalities with 20 shelters, of which 18 participated in the research. All the municipalities maintained dogs, seven (41.2%) maintained cats and eight (47.1%) kept horses. All the shelters had social housing; two (11.8%) of dogs and five (71.5%) of cats housing one animal per pen; four (22,2%) there were pens that didn't have visualization for outside; 11 (64.7%) had cleaning correctly; five (29.4%) shelters that sheltered dogs and one (14.3%) that sheltered cats didn't have area for quarantine and isolation restroom; beds were available in 15 (88.2%), five (71.4%) and one (12.5%) of the pens of dogs, cats and horses, respectively. Animal shelters in Paraná should ban pens isolation, include one bedding per animal and socialize the animals. In addition, there is an opportunity to increase the animal welfare through improvements in animal management and sanitary management, which do not depend on the housing improvements.(AU)

Estilo de vida saludable en estudiantes de enfermería del Estado de México / Healthy Lifestyles in Nursing Students in the State of Mexico / Vida saudável em estudantes de enfermagem no Estado do México

Los estilos de vida de los jóvenes universitarios y la transición a la adultez influyen en los comportamientos y los hábitos de\r\nvida haciéndolos más vulnerables. Objetivo: describir el estilo de vida saludable de los estudiantes de enfermería de la Universidad\r\nAutónoma del Estado de México. Materiales y método: se realizó un estudio descriptivo de corte transversal con 883\r\nestudiantes de enfermería. Se utilizó el cuestionario Estilo de Vida Saludable y Salud en Estudiantes Universitarios EVISAUN\r\nversión 3. El estudio contó con aval académico para su desarrollo. Resultados: el perfil de los participantes fue femenino,\r\nedad promedio de 21 años, dependientes económicamente, y algunos con vinculación laboral. Se encontró nivel de actividad\r\nfísica moderado, y estado de salud y calidad de vida bueno y regular. Las medidas antropométricas muestran un índice de masa corporal promedio de 23,8-24,35 (normal) y circunferencia abdominal dentro de los parámetros normales. El patrón de descanso y sueño es malo, el nivel de estrés alto y las prácticas alimentarias son poco saludables. Conclusión: los resultados muestran que hay factores de riesgo en el estilo de vida de los estudiantes de enfermería participantes. Esto puede mejorarse si se fortalece la adopción de prácticas saludables progresivas que no impliquen cambios drásticos sino transiciones saludables.

University students and their lifestyles represent social importance due to the effect of the transition from young adults to adults that establishes some healthy behaviors and habits, but they are also exposed to harmful ones. Objective: To describe the healthy lifestyles of nursing students at the Universidad Autónoma del Estado de México. Materials and methods: A descriptive and cross-sectional study was conducted with 883 nursing students. The questionnaire EVISAUN Ver. 3 on healthy lifestyles and health in university students was used. The study had academic support for its development. Results: The profile of the participants was female, economically dependent, an average age of 21 years old and some work related. The levels of physical activity were moderate, and good and regular state of health and quality of life. The anthropometric measurements reported average body mass index of 23.8-24.35 (normal) and abdominal circumference within the normal parameters. Sleep patterns are bad and stress levels are high and they have unhealthy eating practices. Conclusion: The results show that there are important risk factors for Mexican nursing students in their lifestyles which can be improved by strengthening the adoption of progressive healthy practices that do not involve drastic changes but healthy transitions.

Os jovens estudantes universitários e seu estilo de vida representam uma importância social devido ao efeito no estágio de transição de jovem para adulto, que instaura comportamentos e hábitos saudáveis, mas também os expõem a outros prejudiciais à sua saúde. Objetivo: descrever os estilos de vida saudáveis dos estudantes de enfermagem na Universidade Autônoma do Estado do México. Materiais e método: foi realizado um estudo descritivo e transversal com 883 estudantes de enfermagem. O questionário sobre estilo de vida saudável e saúde em estudantes universitários foi utilizado EVISAUN Ver. 3. O estudo teve suporte acadêmico para seu desenvolvimento. Resultados: o perfil dos participantes foi feminino, economicamente dependente, idade média de 21 e alguns trabalhadores. Encontramos níveis moderados de atividade física, bom estado de saúde regular e qualidade de vida. As medidas antropométricas mostram um índice de massa corporal de 23,8-24,35 (normal) e circunferência abdominal dentro dos parâmetros normais. O padrão de descanso e sono é ruim, o nível de estresse elevado e as práticas alimentares são insalubres. Conclusão: o estilo de vida do estudante de enfermagem mexicano é acompanhado de importantes fatores de risco que podem ser melhorados se a adoção de práticas saudáveis progressivas, que não envolvam mudanças drásticas, mas transições saudáveis, seja reforçada.

Calidad técnico científica del cuidado de enfermería en el programa de planificación familiar / Scientific technical quality of nursing care in family planning program

Resumen Introducción: Identificar la aplicación de los requerimientos técnico científicos que los profesionales de enfermería tienen en cuenta en el desarrollo del programa de planificación familiar, es importante para orientar la calidad del cuidado y la reducción de riesgos que amenazan la salud de usuarios, acorde con el ideal de atención en salud sexual y reproductiva. Objetivo: Identificar el cumplimiento del profesional de enfermería de los aspectos técnico-científicos del programa de planificación familiar, en una institución de salud. Materiales y métodos: Estudio de corte transversal. Población: usuarios del programa de planificación familiar. Muestra: 345 usuarias, 11 enfermeros. Se aplicó un instrumento que evalúa la calidad del cuidado brindado en relación con: la humanización del cuidado, satisfacción con la atención, cumplimiento de aspectos técnico - científicos y disponibilidad de recursos. Procesamiento y análisis de datos: epidata 3, Stata v12. Resultados: El 97,9% de los profesionales diligencia adecuadamente los formatos de historia clínica y los hallazgos identificados en la consulta. El 98% de las usuarias no recibió asesoría en derechos sexuales y reproductivos. En el 98,5% de los casos de inserción de implante subdérmico, se aplicó el consentimiento informado a usuarias. El 84% de las usuarias no recibió información sobre: el uso del preservativo como método de doble protección, la importancia del autoexamen de mama el 90%, ni de la citología el 60,5%. Conclusiones: Es notoria la falta de información a usuarias sobre cuidados sexuales y reproductivos y los derechos relacionados con estos cuidados. Fue positivo el cumplimiento de aspectos éticos en la atención.

Abstract Introduction: Identifying the technical requirements that nursing professionals must abide when developing the family planning program, is relevant for the quality of care and the reduction of patients' risks, as well as users's health, according to the ideal of sexual and reproductive healthcare. Objective: To identify the nursing professionals' compliance of the technical and scientific aspects of the family planning program in a health institution. Materials and methods: Cross sectional study. Population: Users of the family planning program. Sample: 345 users, 11 nurses. An instrument was implemented for evaluating the quality of care provided in relation to humanization of healthcare, satisfaction with healthcare, compliance with technical and scientific aspects, and availability of resources. Data processing and analysis was performed with Epidata 3, Stata v12. Results: 97.9% of professionals adequately handled the clinical history formats and the findings identified in the consultation. 98% of the users did not receive counselling on sexual and reproductive rights. In 98.5% of cases of subdermal implant insertion, informed consent was obtained. 84% of the users did not receive information about condom use as a double protection method, 90% about the importance of breast self-examination, and 60% of cytology. Conclusions: It is notorious the lack of information to users on sexual and reproductive care and the rights related to this care. The fulfillment of ethical aspects in healthcare was positive.

Coturnicultura como alternativa para aumento de renda do pequeno produtor / Quail production as an alternative to improve income to small farmers

A coturnicultura tem apresentado desenvolvimento significativo nos últimos anos devido às tecnologias empregadas na cadeia produtiva, gerando resultados satisfatórios aos produtores, com baixo custo de investimento. O estudo teve como objetivo avaliar a viabilidade econômico-financeira da coturnicultura para o pequeno produtor rural ou agricultor familiar. Foram utilizados dois grupos com 1.500 aves cada, A1 (aquisição de lote misto com um dia de idade) e A2 (aquisição de fêmeas com 35 dias de idade), e empregados a taxa interna de retorno, o payback simples e o descontado, bem como o valor presente líquido para a análise econômico-financeira. A coturnicultura representa uma alternativa em potencial para agregação de renda ao pequeno produtor/agricultor familiar, pois o retorno do investimento ocorre no segundo ano. Para o início da produção coturnícula, a aquisição de fêmeas aos 35 dias de idade é mais rentável, quando comparada à aquisição de lote misto com um dia de idade. Dessa forma, a alternativa estratégica de comercialização para o início da atividade é o ovo in natura, que possibilita o retorno do investimento em curto prazo.(AU)

Quail production showed significant development in recent years due to technologies used in the production chain, generating satisfactory results for farmers with low cost of investment. The purpose of this study was to evaluate the economic feasibility of quail production implementation for small farmers. A total of 3,000 birds were used and divided in two groups (A1 and A2). The internal rate return was measured, as well as simple payback. The present liquid value for economic and financial analysis was discounted. Quail production is a potential alternative for income increase of small farmers, since the return on investment occurs in the second year. To start quail production, the acquisition of female quails at 35 days of age is more profitable compared to a one day old mixed batch. Thus, the alternative marketing strategy for the beginning of activity is the egg, due to the return on short-term investment.(AU)

Lipid profile of immunocastrated, castrated male and female pigs / Perfil lipídico de suínos machos castrados e imunocastrados e fêmeas

A presente pesquisa foi realizada com o objetivo de avaliar os níveis de colesterol, extrato etéreo, perfil de ácidos graxos e o índice aterogênico e trombogênico da gordura intramuscular de suínos machos imunocastrados em relação às fêmeas e aos machos castrados cirurgicamente. Utilizaram-se 45 animais, com peso inicial de 25,2±2,8kg, distribuídos em delineamento inteiramente ao acaso, com três tratamentos (machos castrados, machos e fêmeas imunocastrados) e três repetições de cinco animais cada. Os animais foram abatidos a 90,3±2,7kg. As amostras de Longissimus dorsi foram coletadas, liofilizadas e analisadas quanto ao perfil de ácidos gordos, colesterol e extrato etéreo. Não foram observadas diferenças (P>0,05) para nenhuma das variáveis analisadas entre a gordura intramuscular de machos castrados cirurgicamente, machos imunocastrados e fêmeas. A imunocastração não alterou os níveis intramusculares de extrato etéreo, colesterol, composição de ácidos graxos ou o índice aterogênico e trombogênico do Longissimus dorsi.(AU)

Análisis de la evidencia disponible para el consumo de edulcorantes no calóricos. Documento de expertos / Analysis of the available evidence for the intake of non-caloric sweeteners. Expert document

Resumen Los edulcorantes no calóricos representan una buena alternativa para sustituir los sabores dulces sin la respuesta fisiológica que genera el consumo de azúcares. Por sí solos no son herramientas para el control de peso. Su consumo debe ir acompañado de una dieta correcta y un estilo de vida saludable que incluya actividad física. Su utilidad radica en proporcionar el agradable sabor dulce sin el aporte energético. La inocuidad de cada uno de los compuestos aprobados está comprobada y se reevalúa constantemente para tomar en cuenta los resultados de nuevos estudios. Debido a que no existe un edulcorante perfecto, la variedad ayuda a que se desarrollen productos cada vez más agradables para el consumidor. Este trabajo es fruto de una revisión exhaustiva de la bibliografía y de las discusiones de un panel de expertos de diversas especialidades: toxicología, ginecoobstetricia, pediatría, endocrinología, nutrición, medicina interna, salud pública y medicina preventiva, en el que se analizó extensamente la bibliografía se revisó una variedad de trabajos científicos que responden a las interrogantes que habitualmente se hacen los profesionales de la salud acerca de seguridad en diferentes grupos etáreos y con afecciones específicas, ingestión diaria admisible, etc.

Abstract Non-caloric sweeteners are a good alternative to replace the sweet flavors without the physiological response generated by the consumption of sugars. Alone they are not tools for weight control. Its intake must be accompanied by a proper diet and a healthy lifestyle that includes physical activity. Its usefulness lies in providing a pleasant sweet taste without the energy intake. The safety of each of the compounds is tested and approved and constantly reassessed to take into account the results of new studies. Since there is no perfect sweetener, variety helps that more and more pleasing to the consumer products are developed. This work is the result of a comprehensive review of the literature and discussions of a panel of experts from various specialties: toxicology, obstetrics and gynecology, pediatrics, endocrinology, nutrition, internal medicine, public health and preventive medicine, where literature was widely analyzed reviewing a variety of scientific papers that address the questions that usually are made by health professionals on safety in different age groups and with specific diseases, acceptable daily intake, etc.

Actinomicetoma en el embarazo. Reporte de un caso: ¿Qué hacer y cómo tratarlo? / Actinomycetoma in pregnancy. Case report: what to do, how to handle?

Resumen ANTECEDENTES: El micetoma es una infección causada por hongos y actinomicetos aeróbicos. Es un padecimiento frecuente en México, con mayor afectación en hombres que en mujeres (3:1). Se caracteriza por aumento de volumen, deformidad del sistio de lesión y formación de fístulas. OBJETIVO: Reportar un caso de actinomicetoma durante el embarazo y analizar el protocolo de tratamiento. CASO CLINICO: Paciente de 29 años de edad, en su cuarto embarazo, con 29 semanas de gestación. El padecimiento se inició 13 años atrás, con dermatosis localizada en la extremidad inferior izquierda, constituida por un nódulo indoloro, que permaneció sin cambios hasta el inicio de la gestación actual, cuando le aparecieron múltiples lesiones nodulares y fístulas. En el examen directo de la secreción se observaron granos y en el cultivo se identificó Nocardia brasiliensis. Después del embarazo a término y con recién nacido sano, si indicó lactancia durante 4 meses y se interrumpió para prescribir bromocriptina. La dermatosis se extendió al doble, sin afectación ósea; se indicó tratamiento con sulfametoxazol-trimetoprima y dapsona. El tiempo total de tratamiento fue de 15 meses y seguimiento sin medicación durante un año. Se obtuvo curación clínica y microbiológica. CONCLUSIONES: El micetoma en mujeres embarazadas es excepcional. La mayor parte de los portocolos de tratamiento deben contraindicarse durante el embarazo. Cuando el micetoma se localiza en una zona que no afecta otros órganos ni se extiende, se sugiere continuar el embarazo y la lactancia sin prescripción de medicamentos pero iniciarla posterior al nacimiento.

Abstract BACKGROUND: Mycetoma is an infection caused by fungi and aerobic actinomycetes. It is a frequent condition in Mexico; it presents less in women than men (1:3). It is characterized by increased volume deformity of the region and sinuses. OBJECTIVE: We present a case of actinomycetoma in a pregnant patient and to analyze the behavior in its therapeutic management CLINICAL CASE: We present female, 29 years old, attending her fourth pregnancy at 29 weeks of gestation. It began 13 years ago with a localized dermatosis of the lower left limb, constituted by a painless nodule, remained unchanged until the beginning of the current gestation, developed multiple nodules and sinuses. A direct examination of the secretion was performed, observing grains, Nocardia brasiliensis was identified. After product birth, lactation was allowed for 4 months and discontinued with bromocriptine. The dermatosis extended to double without bone affection, treatment with sulfamethoxazole/trimethoprim + dapsone was given. Total time was 15 months and follow-up without medication for one year. Clinical and microbiological cure was achieved. CONCLUSIONS: The development of mycetoma in pregnant women is rare, it is important to know the etiology, in eumycetoma all the antimycotics are teratogenic and in actinomycetoma most antibiotics cannot be used in pregnancy with some exceptions. If mycetoma is located in an area that does not compromise other organs or does not spread it is best to leave the course of pregnancy and lactation and then start treatment.