Efectos psiquiátricos de la hipoxia normobárica intermitente. Un Estudio prospectivo

Introducción: La hipoxia intermitente consiste en la administración de aire reducido en oxígeno por episodios, para lograr hipoxia en sangre, alternados con intervalos de normoxia. Tiene uso terapéutico en varias patologías médicas, pero sus efectos psiquiátricos no han sido estudiados. Se han descrito efectos neurogénicos y en modelos animales puede ayudar a prevenir depresión y ansiedad en respuesta al estrés. Objetivo: Determinar la existencia de efectos psiquiátricos de la hipoxia normobárica intermitente en seres humanos. Método: Estudio prospectivo descriptivo. Se incluyeron pacientes mayores de 18 años, que tuvieran programado un plan de hipoxia normobárica intermitente en la clínica Hipoxykine. Se utilizó una ficha de registro y la escala breve de síntomas (BSI) que fue realizada al inicio, mitad (segunda semana) y finalizado el tratamiento (cuarta semana). Resultados: Se incluyeron 22 participantes (50% mujeres) con una mediana de edad de 46 años. Hubo una reducción del índice global de gravedad del BSI estadísticamente significativo (p <0.05) al comparar tanto la primera como la segunda medición respecto a la final. Respecto al análisis según género, esta diferencia fue estadísticamente significativa (p <0.05) en hombres. Conclusiones: La hipoxia normobárica intermitente no produce ni empeora síntomas psiquiátricos y podría tener potencial terapéutico. Se requieren nuevos estudios prospectivos.

Introduction: Intermittent normobaric hypoxia consists of the administration of air reduced in oxygen by episodes, to achieve hypoxia in blood alternated with intervals of normoxia. It has a role in brain development and neuroprotection. However, in the literature there are only studies in animal models. Objective: To determine the existence of psychiatric effects of intermittent normobaric hypoxia in humans. Method: Prospective descriptive study. We included patients over 18 years of age who had an intermittent normobaric hypoxia plan scheduled at the Hipoxykine clinic. A record sheet and the brief symptom inventory (BSI) were carried out at the beginning, middle (second week) and end of treatment (fourth week). Results: We included 22 participants (50% women) with a median age of 46 years. There was a reduction in the overall severity index of the statistically significant (p <0.05) when comparing both the first and second measurements with respect to the final. Regarding the analysis according to gender, this difference was statistically significant (p <0.05) in men. Conclusions: Intermittent normobaric hypoxia does not produce or worsen psychiatric symptoms. It could have therapeutic potential. Further prospective studies are required.

Utilidad de la quimioterapia con corticoides en la reducción de volumen de las lesiones en fetos con malformación congénita de la vía aérea pulmonar (MCVAP): serie de casos / Usefulness of chemotherapy with corticosteroids in reducing the volume of the lesions in fetuses with congenital pulmonary airway malformation (MCVAP): case series

RESUMEN OBJETIVO: el propósito es describir el efecto de los corticoides prenatales en la malformación congénita de la vía aérea pulmonar (MCVAP) mediante la evaluación secuencial del CVR y mostrar la experiencia en nuestro centro de terapia fetal. MATERIALES Y MÉTODOS: serie de casos en la cual se incluyeron ocho pacientes del Hospital de San José; con diagnóstico de MCVAP; se evaluó edad gestacional, el CVR (longitud x largo x ancho, en cms de la masa) x 0.523/circunferencia cefálica) como factor pronóstico, la desviación mediastínica, la presencia de hidrops, el tipo de MCVAP y la localización. Se aplicó betametasona a dosis de inducción de madurez pulmonar fetal. Se realizó la medición del CVR pre y pos tratamiento. Los datos obtenidos fueron analizados mediante el software estadístico SPSS (Versión 11.0 SPSS Inc. Chicago, IL). Se utilizaron la prueba Wilcoxon y el índice de correlación de Spearman según el caso. Un valor de p<0.05 se consideró significativo. RESULTADOS: ocho pacientes fueron incluidas. La mediana de la edad gestacional fue 30.5 semanas. Cuatro casos fueron tipo I, dos tipo II y dos tipo tres. Cuatro casos presentaron desviación mediastinal. Cinco casos fueron derechos y uno bilateral. Ningún caso presentó hidrops. El CVR pre tratamiento fue 0,93(RIQ:0,17-2,1) y pos tratamiento 0,55(RIQ:0,07-1,39). Se encontró una disminución del CVR pos tratamiento en todos los casos (p 0.0117) e índice de correlación de Spearman 0.9524 CONCLUSIÓN: Después de la aplicación de corticoides encontramos una disminución del CVR en todos los casos descritos. El uso de corticoides podría ser parte de la terapia prenatal con miras a mejorar el pronóstico.

ABSTRACT OBJECTIVE: The purpose of this study is to describe the effect of prenatal corticosteroids in the CPAM by sequential evaluation of the CVR, and to show the experience in our fetal therapy center. MATERIALS AND METHODS: Series of cases in which eight patients from the Hospital of San José were included; with diagnosis of CPAM; gestational age was evaluated, CVR (CVR = length x length x width cm, mass) x 0.523 / head circumference) as a prognostic factor, mediastinal shift, hydrops, type of CPAM, location. Betamethasone was applied to fetal lung maturation dose. In all patients underwent CVR measurement pre and post treatment. The data were analyzed using SPSS statistical software (Version 11.0 SPSS Inc. Chicago, IL). The Wilcoxon test and the Spearman correlation index were used according to the case. A value of p <0.05 was considered significant. RESULTS: eight patients were included. The median of gestational age was 30.5 weeks. Four cases were type I, two type II and two type three. Four cases were mediastinal shift. Five cases were rights and one bilateral. No case presented hydrops. The pretreatment CVR was 0,93(RIQ: 0,17-2,1) and post-treatment 0,55(RIQ: 0,07-1,39). We found a decrease in CVR after treatment in all cases (p 0.0117) and Spearman correlation index 0.9524 CONCLUSION: After application of corticosteroids are a reduction in CVR in all the cases described. The use of corticosteroids may be part of prenatal therapy to improve prognosis.

Tricobezoar de estómago / Gastric Trichobezoar Rapunzel Syndrome

Trichobezoars are an unusual pathology that appears generally in young adolescents associated with psychiatric disorders. The clinical presentation is very varied. The diagnosis is suspected by the clinical records of teen agers with trichophagia and trichotillomania and the digestive disorders are confirmed by the results of the endoscopy, the same as with images toward the therapeutic management. Undowbtly the treatment is surgical, and continuation with the psychiatric treatment is essential to avoid a recidival of the disease. Bezoar is a concretion formed in the alimentary tract, and according to the substances forming the ball, we find trichobezoar (foodball). The Rapunzel syndrome is an unusual complication of individual bezoar. When the trichobezoar located in the stomach extends through the pylorus into the small intestine and the right colon, is known as Rapunzel syndrome, that is an extremely rare gastric condition in humans. It is a rare form of trichobezoar, occurring in psychiatric patients with the trichobezoar (hairball) located in the stomach. The syndrome is named after the long haired girl Rapunzel in the fairy tale of the brothers Grimm. Most bezoars in teen agers are trichobezoars from swallowed hair. A 28-year-old patient is presented, with abdominal pain and vomiting, on the general physical examination the patient revealed a severe weight loss. Later on, through a gastrostomy, appeared the trichobezoar, being removed with good postsurgical resullts

Tratamiento de la estenosis traqueobronquial con prótesis: factores de buena respuesta / Treatment of tracheobronchial stenosis with stents: good response factors

OBJETIVO: Determinar predictores de buena respuesta con el uso de prótesis en la estenosis traqueobronquial. MATERIALES Y MÉTODO: Estudio retrospectivo descriptivo de una serie de casos entre junio de 2014 y junio de 2016. Se revisaron registros clínicos, protocolos operatorios, estudios histopatológicos y de imagen. Se consignaron antecedentes demográficos y clínicos al ingreso y luego del procedimiento, etiología de la estenosis traqueal, necesidad de oxígeno en litros, estadía hospitalaria, morbilidad asociada al procedimiento, indicación de terapia complementaria posterior y sobrevida. Se analizaron los datos con estadística descriptiva y analítica. RESULTADOS: Se realizaron 68 procedimientos, en 44 pacientes, 24 mujeres, el diagnóstico principal fue estenosis traqueal con 40 casos. La etiología neoplásica fue el 88% de los casos. El Performance status (PS) de ingreso fue mayor o igual a 2 en el 68% y posterior al procedimiento disminuyó a 22% p < 0,05. En 36 casos los pacientes requerían al menos 1 L de oxígeno lo que disminuyó en 13 casos posterior a la intervención p < 0,05. El tiempo de hospitalización promedio fue 6,2 días (1-60). En 13 pacientes con patología neoplásica se indicó terapia paliativa complementaria. La morbilidad asociada al procedimiento fue de 2,9% dado por prótesis desplazada y lesión iatrogénica. La sobrevida fue de 27% a un año. CONCLUSIONES: La etiología benigna, el PS previo a la intervención menor o igual a 3, requerimiento de oxígeno de 1 litro y obstrucción tumoral menor al 70% del lumen fueron elementos de buena respuesta.

AIM: Determine good response predictors in use of stent in benign and malignant tracheobronchial stenosis. MATERIAL AND METHODS: We retrospectively reviewed medical records of patients submitted to the procedure in the period 2014 to 2016. Clinical records, operative protocols, and histopathological and imaging studies were reviewed. Demographic and clinical data, performance status (PS) at admission and after the procedure, etiology of tracheal stenosis, need for oxygen in liters (L) Post-intervention, hospital stay, procedure-related morbidity, indication of therapy (Chemotherapy and/or Radiotherapy) and survival. Data were analyzed with descriptive and analytics statistics. RESULTS: A total of 68 procedures were performed in 44 patients, 24 women. Tracheal stenosis 40 cases were diagnosed. The malignant etiology was 88%. The admission PS was greater than or equal to 2 in 68% and 22% after the procedure. The oxygen requirements prior to the procedure were at least 1 L in 36 cases and decreased in 13 cases after the procedure. The average hospitalization period was 6.2 days (1-60). Complementary therapy was indicated in 13 patients; the morbidity associated with the procedure was 2.9%, displaced installation and iatrogenic injury. The one year survival was 27%. CONCLUSIONS: Benign etiology, el PS minor than or equal to 3, oxygen requirements prior to the procedure of 1 L and tumoral obstruction less than 75% were good response predictors in our study.

Characterization of Coagulase-Negative Staphylococci and pheno-genotypic beta lactam resistance evaluation in samples from bovine Intramammary infection / Caracterização de Staphylococcus coagulase negativa e avaliação fenogenotípica da resistência aos beta-lactâmicos em amostras oriundas de infecção intra-mamária em bovinos

This study aimed to identify Coagulase-Negative Staphylococci (CoNS) species isolated from bovine mastitis, through phenotypic and PCR-RFLP (Restriction Fragment Length Polymorphism-Polimerase Chain Reaction) methods and to compare both techniques to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) technique. Among them, the PCR-RFLP method, using a partially conserved sequence of the groEL gene, is a promising alternative, because of its reproducibility and reliability. On the other hand, the proteomic technique MALDI-TOF MS provides an accurate and much faster diagnosis and has been increasingly employed in microbiological identification. The pheno-genotypic profiles of beta-lactam resistance were also investigated, this characterization is important, considering that the use of antimicrobials is a key element for mastitis control in dairy farms. The concordance of the phenotypic, PCR-RFLP and MALDI-TOF MS assays to identify CoNS species was 77,5% (31/40). S. chromogenes was the species most frequently isolated. Antibiotic resistance rate was relatively low, registering values of 25.5% to penicillin, 9.6% to oxacillin and 6.2% to cefoxitin. Resistance to imipenem, cephalotin and amoxicillin+clavulanate was not observed. The mecA gene and its variant were detected in 7.6% and 4,1% of the isolates respectively. The blaZ gene was found in 43.2% of the strains resistant to penicillin.(AU)

Este estudo teve como objetivo identificar isolados de Staphylococcus coagulase-negativa (SCN) isolados de mastite bovina, por meio de métodos fenotípicos e PCR-RFLP (reação em cadeia de polimerase - polimorfismo nos fragmentos de restrição), e compará-los com a técnica de tempo de voo de ionização/desorção por laser assistida por matriz de espectrofotometria de massa (MALDI-TOF MS). O método de PCR-RFLP, que utiliza uma parte conservada da sequência do gene groEL, é uma alternativa promissora, por ser reprodutível e confiável. Por outro lado, a técnica proteômica MALDI-TOF MS permite uma acurácia e um diagnóstico muito mais rápidos e tem sido cada vez mais empregada na identificação microbiológica. Os perfis fenogenotípicos de resistência aos beta-lactâmicos também foram investigados. Essa caracterização é importante, considerando-se que os antimicrobianos são os elementos-chave para o controle da mastite na produção leiteira. A concordância entre os testes fenotípicos, PCR-RFLP E MALDI-TOF MS na identificação foi de 77,5% (31/40). S. chromogenes foi a espécie mais frequentemente isolada. A resistência antimicrobiana foi relativamente baixa, apresentando valores de 25,5% para penicilina, 9,6% para oxacilina e 6,2% para cefoxitina. Resistência ao imipenem, à cefalotina e à amoxacilina + ácido clavulâncico não foi observada. O gene mecA e sua variante foram detectados em 7,6% e 4,1% dos isolados, respectivamente. O gene blaZ foi encontrado em 43,2% dos isolados resistentes à penicilina.(AU)

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

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

Grupos focales de discusión: estrategia para la investigación sobre salud sexual con adolescentes con experiencia de vida en calle en Medellín, Colombia / Discussion focus groups: a strategy for research on sexual health with adolescents who have lived on the streets of Medellin, Colombia / Grupos focais de discussão: estratégia para a investigação sobre saúde sexual com adolescentes com experiência de vida na Rua em Medellín, Colômbia

RESUMEN La intención de este artículo es evidenciar la importancia de los grupos focales de discusión como estrategia metodológica para la recolección de información en el trabajo con adolescentes institucionalizados con experiencia de vida en calle y, al mismo tiempo, mostrar su valor en el abordaje de la salud sexual con esta población, en tanto que permite una interacción flexible y reflexiva entre investigadores y participantes, así como de los participantes entre sí. El valor de esta estrategia metodológica es sustentado en este artículo mediante testimonios y resultados obtenidos durante su implementación en el estudio llevado a cabo con adolescentes institucionalizados entre 2013 y 2014 en Medellín. Se espera con este reducir las creencias de profesionales con respecto a las limitaciones de la estrategia para abordar temáticas relacionadas con la salud sexual de este grupo poblacional. Los resultados se articulan en cuatro categorías: conocimientos y percepciones sobre VIH e ITS, salud sexual y reproductiva (SSR), el lenguaje en la SSR, y acceso y uso de las tecnologías de la información y la comunicación (TIC). De esta manera se deja de manifiesto el aporte y potencial de la estrategia para el abordaje del tema y para el acercamiento e interacción con adolescentes con experiencia de vida en calle.

ABSTRACT This paper aims to show the importance of discussion focus groups as a methodological strategy for the compilation of information in studies with institutionalized adolescents who have lived on the streets. At the same time, it aims to show the value of this technique in approaching the topic of sexual health with this population, since it allows for flexible and reflexive researcherparticipant and participant-participant interaction. The value of this methodological strategy is supported in this article through accounts and results obtained during the implementation of a study conducted with institutionalized adolescents between 2013 and 2014. We expect these results will reduce the beliefs of professionals regarding the limitations of the strategy to address issues related to the sexual health of this type of population. The results are divided into four categories: knowledge and perceptions of HIV and STIs, sexual and reproductive health (SRH), the language used in SRH, and access to and use of information and communications technology (ICT). Thus, this paper clearly shows the contribution and potential of the strategy for addressing the issue, approaching and interacting with adolescents who have lived on the street.

RESUMO A intenção deste artículo é evidenciar a importância dos grupos focais de discussão como estratégia metodológica para a recolecção de informação no trabalho com adolescentes institucionalizados com experiência de vida na rua e, ao mesmo tempo, mostrar o seu valor na abordagem da saúde sexual com esta população, entanto que permite uma interação flexível e reflexiva entre investigadores e participantes, assim como dos participantes entre eles. O valor desta estratégia metodológica é sustentado neste artigo mediante testemunhos e resultados obtidos durante a sua implementação em estudo levado a cabo com adolescentes institucionalizados entre 2013 e 2014 em Medellín. Espreitando com isto reduzir as crenças de profissionais com respeito ás limitações da estratégia para abordar temáticas relacionadas com a saúde sexual de este grupo populacional. Os resultados se articulam em quatro categorias: conhecimentos e percepções sobre VIH e ITS, saúde sexual e reprodutiva (SSR), a linguajem na SSR, e acesso e uso das tecnologias da informação e a comunicação (TIC). Desta maneira se deixa de manifesto o aporte e potencial da estratégia para a abordagem do tema e para a proximidade e interação com adolescentes com experiência de vida na rua.

Proceso enfermero de tercera generación / Third generation nursing process / Processo enfermeiro de terceira geração

Introducción: Hoy en día el proceso de enfermería ha evolucionado a una tercera generación como resultado de que la comunidad científica de esta área ha adoptado un cambio en la misma metodología por la que se guía. Su desarrollo en cinco etapas (valoración, diagnóstico, planeación, ejecución y evaluación) se sustenta con la mejor evidencia científica, actualmente se considera como tal a las taxonomías de enfermería de la North American Nursing Diagnosis Association International , la Nursing Outcomes Classification y la Nursing Interventions Classification , las cuales se han convertido en lenguajes propios de la disciplina reconocidos internacionalmente. Desarrollo: La tercera generación del proceso enfermero se enfoca en establecer cuidadosamente los beneficios de centrar los cuidados en los resultados actuales, los esperados y los obtenidos, a diferencia de la primera y segunda generación que encauzaban los cuidados de enfermería en la resolución de problemas del paciente o el mismo diagnóstico del paciente. Conclusión: Implementar el proceso enfermero de tercera generación impone la innegable capacidad de aplicar habilidades críticas, metacognoscitivas y de pensamiento crítico, esta aplicación comienza a permear en las instituciones de salud y educativas en México.

Introduction: As a result of changes in its scientific guiding methodology, the nursing process has evolved into its third generation. Its implementation in five stages (assessment, diagnosis, planning, execution, and evaluation) is based on the best scientific evidence in agreement with the discipline-internationally-recognized nursing taxonomies of the North American Nursing Diagnosis Association International , the Nursing Outcomes Classification , and the Nursing Interventions Classification . Development: The third generation nursing process carefully focuses on the benefits of the actual, expected and achieved care outcomes, rather than conducting diagnostics and problem-solving tasks which characterize the first and second generation nursing processes. Conclusion: While the approach is gradually emerging in institutions of health and education in Mexico, the third generation nursing process requires a careful use of cognitive and critical thinking skills.

Introdução: Hoje em dia o processo de enfermagem tem evoluído a uma terceira geração como resultado de que a comunidade cientifica desta área tem adotado um câmbio na mesma metodologia pela que se guia. Seu desenvolvimento em cinco etapas (valorização, diagnóstico, planejamento, execução e avaliação) sustenta-se com a melhor evidencia científica, atualmente considera-se como tal às taxonomias de enfermagem da North American Nursing Diagnosis Association International , a Nursing Outcomes Classification e a Nursing Interventions Classification , as quais tornaram-se em linguagens próprias da disciplina reconhecidas internacionalmente. Desenvolvimento: A terceira geração do processo enfermeiro focaliza-se em estabelecer cuidadosamente os benefícios de centrar os cuidados nos resultados atuais, os esperados e os obtidos, a diferencia da primeira e a segunda geração que encaminhavam os cuidados de enfermagem na resolução de problemas do paciente ou o mesmo diagnóstico do paciente. Conclusão: Implementar o processo enfermeiro de terceira geração impõe a inegável capacidade de aplicar habilidades críticas, metacognoscitivas e de pensamento crítico, esta aplicação começa a permear nas instituições de saúde e educativas no México.

Estatus funcional de adultos mayores de Tláhuac, Ciudad de México / Functional status of senior adults in Tlahuac, Mexico City / Status funcional de idosos de Tláhuac, Cidade do México

Resumen La identificación de la capacidad de funcionalidad en el adulto mayor es una valoración conveniente. Se concibe que la funcionalidad está relacionada con lograr satisfacer sus necesidades básicas, bienestar emocional y social, significa independencia y, por lo tanto, con calidad de vida. El objetivo de este estudio fue identificar el grado de funcionalidad que presentan los adultos mayores de 60 años y mayores que asisten a consulta en 4 centros de salud ubicados en la delegación Tláhuac, Ciudad de México durante el periodo de junio a diciembre de 2014. Fue una investigación exploratoria, en una muestra por conveniencia de 754 adultos mayores; se utilizaron 5 ítems del apartado A del instrumento "Evaluación Funcional del Adulto Mayor" el cual fue aplicado en los centros de salud. Para el procesamiento de la información se utilizó estadística descriptiva. Resultados: El 82% de los adultos mayores fueron independientes y el 18% están en riesgo de dependencia. Las actividades que presentaron menor porcentaje de dependencia fueron preparar sus alimentos y realizar tareas domésticas. Conclusión: Los resultados arrojados en el presente estudio implican sensibilizar a los profesionales de los centros de salud para que incorporen en sus programas propuestas para mantener la funcionalidad en este grupo etario como son ejercicio mental y físico, hábitos alimentarios, ocupación del tiempo y el manejo de situaciones estresantes.

Abstract It is important to address the functional status of senior adults because this is an indicator of their capacities to fulfill their basic needs, as well as to have emotional and social wellbeing, and thus to live a life with quality and independence. The objective of this study was to identify the degree of functionality in seniors 60 years and older who visit four health centers in Tlahuac, Mexico City. Data were collected from June to December 2014. This was an exploratory study on a convenience sample of 754 senior adults. Five items from the section A of the instrument Senior Adult Functional Status (Evaluación Funcional del Adulto Mayor (EFAM)) were used. The questions were asked in the health centers. Descriptive statistics were performed. Results: 82% of the seniors showed being independent while 18% were at risk of being dependent. The activities which demonstrated lower percentage of dependence were preparation of their food and performing their domestic tasks, Conclusion: The findings of this study suggest that health professionals should be sensitized to incorporate proposals in their programs to help maintain the functional status of this population. These activities should focus on: physical and mental exercise, good dietary habits, adequate use of time, and stress management.

Resumo A identificação da capacidade de funcionalidade em idosos é uma valorização conveniente. Concebendo que a funcionalidade está relacionada em conseguir satisfazer suas necessidades básicas, bem-estar emocional e social, significa independência, neste conceito a qualidade de vida está considerada. O objetivo deste estudo foi identificar o grau de funcionalidade que apresentam os idosos de 60 anos e mais velhos, que assistem a consulta em quatro centros de saúde localizados no município Tláhuac, Cidade de México, durante o período de junho a dezembro de 2014. Foi uma pesquisa exploratória, em uma amostra de conveniência de 754 idosos, utilizaram-se cinco itens do apartado A do instrumento "Avaliação Funcional do Idoso" (EFAM), o qual foi aplicado nos centros de saúde. Para o processamento da informação utilizou-se estatística descritiva. Resultados: O 82% dos idosos foram independentes e o 18% estão em risco de dependência. As atividades que apresentaram menor porcentagem de dependência foram preparar seus alimentos e realizar fazeres domésticos. Conclusão: Os resultados obtidos no presente estudo procuram sensibilizar aos professionais dos centros de saúde para que incorporem nos seus programas, propostas para manter a funcionalidade neste grupo etário como são o exercício físico e mental, hábitos alimentares, ocupação do tempo e o manejo de situações estressantes.

Síndrome de Cogan típico: a propósito de un caso / Typical Cogan’s syndrome: report of a case

Introducción: El síndrome de Cogan es una entidad poco frecuente, de origen autoinmune.Se caracteriza por queratitis intersticial no sifilítica asociada a síntomasaudiovestibulares similares al síndrome de Ménière. Los primeros síntomas ocularesincluyen enrojecimiento y fotofobia, a los que se puede agregar conjuntivitis o uveítis.Objetivo: Presentar un caso de síndrome de Cogan típico y describir las principalescaracterísticas de la entidad.Caso clínico: Varón, 32 años, sin antecedentes mórbidos. Consulta por cuadro de cuatrodías de evolución caracterizado por dolor ocular e inyección conjuntival. Diagnosticadoen un comienzo con sinusitis y conjuntivitis aguda y se maneja como tal. Alpersistir sintomatología se hospitaliza a la semana evidenciándose fiebre, inyecciónconjuntival bilateral y a los pocos días hipoacusia. Los exámenes de laboratorio destacanleucocitosis, trombocitosis, PCR, VHS e IgA elevadas. Autoanticuerpos y estudiopara VIH y VHC negativos, TAC de cerebro y cavidades paranasales normales. Evaluadopor oftalmología y otorrinolaringología, describiéndose hiperemia conjuntival yquemosis, e hipoacusia neurosensorial de probable origen autoinmune, respectivamente.Evaluado por reumatología, se plantea síndrome de Cogan típico. Se indicaprednisona 1 mg/kg/día, metilprednisolona por dos días y metotrexato semanal, conbuena respuesta. Evoluciona con disminución de cefalea, de compromiso ocular ehipoacusia, afebril, dándose de alta con prednisona y metotrexato. Control al mesdel alta, paciente asintomático, se mantiene tratamiento. Control en oftalmología20 días después, objetivándose leve edema corneal, por lo que se indica tratamientotópico...

Background: Cogan’s syndrome is a rare entity of autoimmune origin. It is characterizedby non-syphilitic interstitial keratitis associated with audiovestibular symptomssimilar to Meniere’s syndrome. Early symptoms include eye redness and photophobia,which can be added conjunctivitis or uveitis.Objective: To report a case of typical Cogan’s syndrome and describe the main featuresof the entity.Case report: Male, 32, no morbid history. Consults for story of 4 days of evolutioncharacterized by eye pain and conjunctival injection. Initially diagnosed with sinusitisand acute conjunctivitis and handled as such. By persisting symptoms is hospitalizeda week later demonstrating fever, bilateral conjunctival injection and in a few dayshearing loss. Laboratory tests include leukocytosis, thrombocytosis, and elevatedPCR, VHS and IgA. Autoantibodies, HIV and HCV study were negative, brain and sinusesCT normal. Reviewed by ophthalmology and otolaryngology, describing conjunctivalhyperemia and chemosis, and sensorineural hearing loss of probable autoimmuneorigin, respectively. Evaluated by rheumatology, typical Cogan’s syndrome arises. It isindicated prednisone 1 mg/kg/day, methylprednisolone for 2 days and weekly methotrexate,with good response. Evolves with decreased in headache, eye commitmentand hearing loss, afebrile, was discharged with prednisone and methotrexate. Controla month after discharge, asymptomatic, treatment is maintained. Control 20 days laterin ophthalmology, objectifying mild corneal edema, so topical treatment indicated...

Parasitosis intestinales en Altragracia de la Montaña, Estado Miranda, Venezuela: Influencia del programa para la eliminación de oncocercosis / Intestinal parasites in Altragracia de la Montaña, Miranda State, Venezuela: Influence of the program for onchocerciasis elimination

El objetivo general de este trabajo fue determinar la prevalencia de parasitosis intestinales y sus características epidemiológicas en cuatro comunidades de la parroquia Altagracia de la Montaña, Estado Miranda (Venezuela). Se desarrolló un estudio de corte transversal con una muestra constituida por 492 en su mayoría niños, en febrero de 2011. Previo consentimiento informado, se realizó una encuesta clínico-epidemiológica, extracción de sangre y exámenes coproparasitológicos con los métodos directo, Kato y cultivo en agar. El 60% de la población tenía al menos un parásito de transmisión hídrica y/o alimentos contaminados por heces de humanos y/o animales. La elevada frecuencia de protozoarios intestinales, especialmente Blastocystis sp., con predominio entre quienes viven con fallas en la disposición de excretas y baja calidad del agua para consumo humano, demuestran la persistencia de parasitosis intestinales como problema de salud pública; sin embargo, la influencia indirecta de la administración semestral de ivermectina y educación sanitaria con visión etnográfica impartida por el Programa para la Eliminación de Oncocercosis en Bucarito, una de las comunidades evaluadas, tuvo como efecto colateral no sólo disminuir la prevalencia de helmintos intestinales, sino de los protozoarios, a pesar de estar sometida a los mismos factores de riesgo que las comunidades restantes.

The aim of this study was to determine the prevalence of intestinal parasites and their epidemiological characteristics in four rural communities from Altagracia de la Montaña, Miranda State (Venezuela). A cross sectional study was conducted in February 2011 where 492 subjects were evaluated, mostly children. Informed consent was previously obtained. A clinical and epidemiological survey was done. Patients voluntarily brought a fresh stool sample for analysis with direct smear, Kato and agar culture; blood was extracted for eosinophil count. 60% of the evaluated people had at least one parasite transmitted by water or food contaminated by human or animal feces. The high prevalence of protozoa, specially Blastocystis sp., among those who live under poor living conditions such as inadequate feces disposal and low quality of drinking water, shows the persistence of intestinal parasites as a public health problem; nevertheless, indirect influence of ivermectin treatment every six months and health education with an ethnographic orientation given by the Onchocerciasis Elimination Programme in Bucarito, one of the evaluated communities, had an unexpected outcome not only diminishing the prevalence of helminthes but also the prevalence of intestinal protozoa, being this community under the same risk factors as the rest of the evaluated communities.

Importancia del pensamiento reflexivo y crítico en enfermería / Importance of reflective and critical thinking in nursing", "_e": "n

Pensar de manera reflexiva y crítica permite conocer y discriminar una acción de otra, en función de las prioridades establecidas para la atención de la persona, interactuando con ella de manera emancipadora, donde deben buscarse formas o puentes de unión entre la parte más artística de la enfermería y aquellos elementos más asociados al campo de la ciencia, procurando así una mayor calidad en la prestación de los cuidados. El desarrollo del pensamiento reflexivo y crítico en los estudiantes de enfermería en México es un tema poco estudiado. En este artículo se hace una revisión sobre lo investigado y escrito, imprescindible en la agenda educativa de enfermería, así como algunas reflexiones y posicionamientos de un grupo colegiado, perteneciente a la región México y El Caribe de la Red Iberoamericana de Investigación en Educación en Enfermería (RIIEE).

Think in a reflexive and critical way allows knowing and distinguishing one action of another, according to established priorities for the care of person interacting in a emancipatory way, where ways or links between the most artistic part of nursing and those elements associated with the field of science should be looked for, in order to give a better quality in professional care of nursing. The development of reflexive and critical thinking in students of nursing in Mexico, it is a subject that hasn’t been researched enough. This article a review is made about what has been researched and written, essential subject in the field education in Nursing, as well as some reflections and stance of association from Mexico and The Caribbean region, of the Red Iberoamericana de Investigación en Educación en Enfermería (RIIEE).

Unilateral Triplication of Superior Cerebellar Artery Associated with Fetal Posterior Cerebral Artery: Case Report.

Introduction: Superior cerebellar artery is the most constant among the cerebellar arteries and is almost always present, sometimes it can be double, and more rarely, triple. Methods: We report the case of a 72-yr male patient who came to hospital in whom cerebral angiography was performed because of subarachnoid hemorrhage. Results: cerebral angiography showed the unusual presence of an embryonic right posterior cerebral artery, associated with triplication of the right superior cerebellar artery. Conclusion: Th e tripling of the SCA is seen in only 7% of angiographic abnormalities and rarely is associated with posterior communicating artery aneurysms and embryonic posterior cerebral artery, as in our case.

Síndrome de Lemierre: una entidad clínica casi en el olvido: reporte de tres casos y revisión de la literatura / Lemierre´s syndrome: an almost forgotten clinical entity: three case reports and literature review

Lemierre’s syndrome is a rare disease that affects young adults and is mainly caused by Fusobacterium necrophorum and occasionally by other anaerobic bacteria of the species. This syndrome is characterized by a throat infection complicated with septic thrombophlebitis of the internal jugular vein and septic emboli mainly to the lungs. In the pre-antibiotic era its evolution was often fatal. Since the 1960’s this syndrome has rarely been reported given the extensive use of penicillin en pharyngeal infections. Currently the incidence of Lemierre’s syndrome is about one in a million. Currently, since imaging has a key role in the early diagnosis of this syndrome, the radiologist should be aware of and recognize its manifestations. Three cases of Lemierre’s syndrome and a literature review are presented.

El síndrome de Lemierre es una enfermedad rara que afecta a adultos jóvenes y es causada principalmente por Fusobacterium necrophorum y ocasionalmente por otras bacterias anaerobias de la especie. Este síndrome se caracteriza por una infección faríngea complicada con tromboflebitis séptica de la vena yugular interna y embolias sépticas principalmente a los pulmones. En la era pre-antibióticos su evolución era frecuentemente de curso fatal. Desde los años 60 este síndrome ha sido rara vez reportado dado el extensivo uso de penicilina en infecciones faríngeas. Actualmente la incidencia del síndrome de Lemierre es de aproximadamente uno en un millón. Dado que hoy en día las imágenes tienen un rol fundamental en el diagnóstico temprano de este síndrome el radiólogo debe estar al tanto y reconocer sus manifestaciones. Se presentan tres casos de Síndrome de Lemierre y una revisión de la literaratura.

Consumo de alcohol en el adulto mayor chileno que viaja / Alcohol consumption among traveling Chilean older people

Background: Problems associated with alcohol consumption are prevalent in Chile, but little is known about the situation in the elderly. Aim: To perform a screening to detect alcohol-related problems and risks in the Chilean older people who travel. Material and Methods: The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was answered by 1,076 travelers aged 60 to 93 years (66% females), who participated in trips organized by the Chilean National Tourism Service (SERNATUR). Results: Seventy six percent of respondents acknowledged to have ingested an alcoholic drink during the last month. The average AUDIT score was of 2.2 ± 2.6. Only 3.7% of the sample had a score equal or higher than eight, considered as risky use. Within this last group, 60% had symptoms of alcohol dependence. A higher alcohol consumption was associated with male gender (p < 0.01), being younger than 75 years of age (p < 0.01), having a medium-low economic income (p < 0.01) and having a higher education level (p = 0.03). There was no significant association with the respondents´ occupation. Conclusions: In this sample of Chilean traveling older people, there was a high prevalence of alcohol consumption, and nearly 4% of respondents had alcohol related problems.

Niveles de vitamina D en adultos mayores saludables chilenos y su relación con desempeño functional / Vitamin D levels in older healthy Chilean adults and their association with functional performance

Background: People over 60 years old are at risk of Vitamin D deficiency, which can affect functional performance, since this vitamin is involved in muscle function and protein synthesis. Aim: To measure 25OH vitamin D levels in healthy older people from Santiago de Chile, and evaluate their relationship with functional performance. Subjects and Methods: Healthy subjects aged 60 years or more and living in the community were invited to participate. People with chronic diseases, cognitive impairment, physical disability, smokers and those consuming more than three medications per day were excluded. Hand grip and gait speed were measured and a blood sample was obtained to measure 25OH vitamin D by radioimmunoanalysis. Results: One hundred and four participants aged 60 to 98 years (55% females) were studied. Mean vitamin D levels were 17.3 ± 6.1 ng/mL. Females had lower levels than males (15.6 ± 5.8 and 19.2 ± 6.0 ng/mL respectively p < 0.01). Eighty three percent of females and 55.3% of males had values below 20 ng/mL (the cutoff point for deficiency). Only 3.5% of females and 8.5% of males had values of 30 ng/ml or higher. There was a significant correlation between vitamin D levels, gait speed and grip strength (r = 0.32 and 0.34 respectively, p < 0.01), especially in women over 74 years. Conclusions: Vitamin D deficiency is almost universal in healthy adults over 60 years living in Santiago de Chile, especially in women. This deficiency is associated with a deranged functional performance and is a potentially modifiable risk factor for disability.

Relación entre dermatitis atópica y alergia alimentaria / Relationship between atopic dermatitis and food allergy

La denominada "marcha alérgica" se caracteriza por diferentes manifestaciones atópicas relacionadas y sucesivas a lo largo de la vida del individuo. Los niños que presentan alergia alimentaria (AA) tienen mayor predisposición al desarrollo de otras enfermedades alérgicas entre las cuales destacan dermatitis atópica (DA), asma y rinitis alérgica. La DA y AA coexisten en mayor medida en los pacientes que presentan DA de comienzo precoz, agresiva y persistente. Por su parte, la AlA es un factor precipitante de DA en un subgrupo de pacientes especialmente aquellos con AA mediadas por IgE, y también existiría correlación con las manifestaciones de AA de tipo retardadas. La disfunción en la barrera epitelial principalmente atribuida a mutaciones en el gen de la filagrina se ha descrito como posible desencadenante de la sensibilización a alérgenos por aumento de la permeabilidad cutánea. Se describen las características generales de la DA y evidencias de investigaciones actuales con respecto al rol de la AA sobre el desarrollo de la DA, su manejo y estrategias de prevención. Se discute la utilidad de los exámenes para el diagnóstico y las indicaciones de tratamiento y prevención en el manejo de niños con DA y AA. La restauración de las alteraciones de la barrera cutánea para prevenir la sensibilización antigénica tendría un rol importante para evitar el desarrollo de enfermedades alérgicas especialmente respiratorias.

The term "allergic march" refers to the history of different atopic manifestations throughout the patient's life. Children with food allergy (FA) are more predisposed to the development of other allergic diseases such as atopic dermatitis (AD), asthma and allergic rhinitis. AlD and FA coexist to a greater extent in patients with early signs of AD, aggressive and persistent symptoms. Meanwhile, FA is a precipitating factor to AlD especially in patients with IgE-mediated FA. Correlation to delayed manifestations of FA may also be found. Epithelial barrier dysfunction, mainly attributed to mutations in the filaggrin gene, has been described as a possible trigger for allergen sensitization by increasing skin permeability. This study describes general characteristics of DA and current research evidence regarding the role of FA in the DA development, management and prevention strategies. Also, the utility of diagnostic tests, treatment and prevention in children with DA and FA are discussed. The restoration of impaired skin barrier to prevent sensitization to antigens may have an important role to prevent the development of allergic diseases, especially respiratory diseases.