Grupo centrado: experiência com mulheres na vivência do ciclo gravídico puerperal / Centered group: a study with women experiencing pregnancy-puerperal cycle / Grupo focal: experiencia con mujeres en la vivencia del ciclo de embarazo puerperal

OBJETIVO: Compreender experiência de grupo orientado pela Abordagem Centrada na Pessoa (ACP) com mulheres que vivenciam o ciclo gravídico puerperal, no contexto do Sistema Único de Saúde (SUS). MÉTODO: Pesquisa qualitativa, de inspiração fenomenológica, e utilização do referencial da ACP como norteador do estudo. As informações foram coletadas por meio de grupo, em quatro encontros presenciais nos meses de maio e junho de 2022, utilizando-se dos instrumentos Versão de Sentido (VS's) e Entrevista Fenomenológica (EF), sendo as informações organizadas em Eixos de Sentido e compreendidas a partir das premissas da ACP em diálogo com estudos vinculados às temáticas emergidas. RESULTADOS E DISCUSSÃO: Os Eixos elaborados a partir das VS's evidenciaram aspectos e tendências típicas do desenvolvimento de grupo fundamentado pela ACP; descreveram o grupo como espaço de acolhimento e liberdade experiencial, no qual se facilitou a expressão de vivências significativas relacionadas à gestação, parto e puerpério; apresentaram, ainda, o sentido de que a experiência grupal constituiu-se como promotora de trocas e apoio mútuo, de desenvolvimento e aprendizagens significativas. Os Eixos formulados com base na EF revelaram que as mulheres compreenderam a participação no grupo como uma experiência positiva, que propiciou cuidado aos aspectos emocionais, impulsionando autoconhecimento e desenvolvimento; e facilitadora de mudanças construtivas na vivência da maternidade. CONCLUSÃO: O estudo demonstrou a viabilidade de grupo centrado na assistência integral à saúde da mulher no período gravídico puerperal, e as convergências entre os princípios da ACP e os que orientam a prática na assistência do SUS.

OBJECTIVE: Understanding the group guided by the Person-Centered Approach (PCA) with women who experience the pregnancypuerperal cycle, in the Sistema Único de Saúde ­ SUS (Brazilian National Health System) context. METHOD: Qualitative research of phenomenological inspiration using the PCA framework as a guide for the study. Information was collected through groups, in four face-to-face meetings between May and June 2022, using the Sense's Version (SV's) and Phenomenological Interview (PI), with the information organized in Sense Axes and understood from the premises of the PCA in dialogue with studies linked to emerging themes. RESULTS AND DISCUSSION: The Axes created from the SV's showed aspects and tendencies which are typical of the development of a group based on the PCA; described the group as a welcoming space and experiential freedom, in which the expression of significant experiences related to pregnancy, childbirth and puerperium was facilitated; they also presented, the sense that the group experience was constituted as a promoter of exchanges and mutual support, of development and significant learning. The Axes formulated based on the PI, revealed that the women understood participation in the group as a positive experience, which provided care for emotional aspects, boosting self-knowledge and development; and a facilitator of constructive changes in the experience of motherhood. CONCLUSION: The study demonstrated the viability of a group centered on comprehensive care for women's health in the pregnancy-puerperal period between the PCA principles and those that guide the SUS care practice.

OBJETIVO: Comprender la experiencia de grupo orientado por el Enfoque Centrado en la Persona (ACP) con mujeres que vivenciaron el ciclo de embarazo puerperal, en el contexto del Sistema Único de Saúde ­ SUS (Sistema Único de Salud). MÉTODO: Pesquisa cualitativa de inspiración fenomenológica e utilización del referencial de la ACP como guía de estudio. Las informaciones fueron colectadas por medio de un grupo, en cuatro encuentros presenciales en los meses de mayo y junio del 2022, utilizando-se de los instrumentos Versiones del Sentido (VS's) e Entrevista Fenomenológica (EF), siendo las informaciones organizadas en Ejes del Sentido y comprendidas a partir de las premisas de la ACP en dialogo con estudios vinculados a las temáticas emergidas. RESULTADOS Y DISCUSIONES: Los Ejes elaborados a partir de las VS's evidenciaron aspectos y tendencias típicas del desarrollo del grupo fundamentado por la ACP, describieron el grupo como espacio de acogimiento y libertad experimental en lo cual se facilitó expresar las vivencias significativas relacionadas a la gestación, el parto y el puerperio, presentaron todavía, el sentido de que la experiencia grupal e constituyó como promotora de cambios y apoyos mutuos, de desarrollo y aprendizajes significativos. Los Ejes formulados con base en la EF, revelaron que las mujeres comprendieron la participación en el grupo como una experiencia positiva que les proporcionó cuidados a los aspectos emocionales aumentando el autoconocimiento y desarrollo; y facilitadora de cambios constructivos en la vivencia de la maternidad. CONCLUSIÓN: El estudio demostró la viabilidad del grupo enfocado en la asistencia integral a la salud de la mujer en el período del embarazo puerperal, y las convergencias entre los principios de la ACP y los que orientan la practica en la asistencia del SUS.

Atypical evolution of collapsing FSGS in extreme elderly: case report / Evolução atípica de GESF Colapsante na velhice extrema: relato de caso

Introduction: Segmental and Focal Glomerulosclerosis (FSGS) is an entity characterized by glomerular damage involving the podocyte as the main target. A variant with a worse prognosis, poor response to corticosteroid therapy, and rapid progression to end-stage renal disease is recognized as collapsing FSGS. Case Report: A 102-year-old man with nephrotic syndrome and acute kidney injury underwent renal biopsy, revealing collapsing FSGS. He achieved an excellent response to immunosuppressive treatment, presenting renal recovery, and was discharged from dialysis treatment. Discussion: Diagnosis and definition of treatment in the elderly are challenging, and each case must be individualized and have functionality and risk assessed in a naturally immunosuppressed population.

Introdução: Glomeruloesclerose Segmentar e Focal (GESF) é uma entidade caracterizada por lesão glomerular que envolve o podócito como principal alvo. Uma variante de pior prognóstico, baixa resposta à corticoterapia, e rápida evolução para doença renal terminal é reconhecida como GESF colapsante. Relato de Caso: Um homem de 102 anos com síndrome nefrótica e lesão renal aguda foi submetido a biópsia renal, revelando GESF colapsante. Ele obteve excelente resposta ao tratamento imunossupressor, apresentando recuperação renal e recebendo alta de terapia renal substitutiva. Discussão: Diagnóstico e definição de tratamento nos idosos são desafiadores, devendo-se individualizar cada caso, avaliar funcionalidade e risco em uma população naturalmente imunossupressa.

Perception of Medical Students Regarding Implementing Telemedicine Practice Activities at a University Center in Brazil / Percepção de Estudantes de Medicina sobre a Implementação de Vivências em Telemedicina em um Centro Universitário do Brasil

Objective: evaluate medical students' perceptions regarding implementing Telemedicine teaching during their undergraduate studies. Methods: this is a cross-sectional qualitative study with 30 medical students. Three focus group sessions were conducted, and the data were analyzed using a content analysis approach. Results/Discussion: the students recognized the importance of digital health strategies and digital information and communication technologies (ICTs) for the healthcare ecosystem. However, some students pointed out that this area is still challenging for some doctors who oppose Telemedicine. They reported a need for training professionals and students, emphasizing the need to improve skills and competencies for teleconsultation and other Telemedicine modalities. They stated that these experiences helped them enhance their empathy skills for establishing a good doctor-patient relationship. When referring to the negative aspects of the experiences, they mentioned the dependence on reliable internet connection and digital tools. Another limitation mentioned was the difficulty in conducting specific physical examination components. Conclusions: the students experienced Telemedicine activities in a safe healthcare environment, learning about the bioethical principles for responsible teleconsultations, understanding the limiting factors of the method, and having the opportunity to improve skills and competencies for their future professional practice.

Objetivo: avaliar a percepção dos estudantes de Medicina quanto à implementação do ensino da Telemedicina durante a graduação. Métodos: trata-se de um estudo qualitativo transversal com 30 alunos do curso de Medicina. Foram realizadas três sessões de grupos focais e os dados foram analisados através de uma abordagem de análise de conteúdo. Resultados/Discussão: os estudantes reconheceram a importância das estratégias de Saúde Digital e das Tecnologias Digitais de Informação e Comunicação (TIC) para o ecossistema de saúde. Contudo, alguns estudantes apontaram que esta área ainda é um desafio para alguns médicos que se opõem à prática da Telemedicina. Relataram a necessidade de capacitação de profissionais e estudantes, enfatizando a necessidade de aprimoramento de habilidades e competências para teleconsultas e outras modalidades de Telemedicina. Afirmaram que as vivências os ajudaram a melhorar as suas capacidades de empatia para estabelecer uma boa relação médico-paciente. Ao se referirem aos aspectos negativos das atividades, mencionaram a dependência de conexão confiável à internet e de ferramentas digitais. Outra limitação citada foi a dificuldade na realização de etapas específicas do exame físico. Conclusões: os estudantes vivenciaram as atividades de Telemedicina em um ambiente de saúde seguro, conhecendo os princípios bioéticos para a prática de teleconsultas responsáveis, compreendendo os fatores limitantes do método e tendo a oportunidade de aprimorar habilidades e competências para a sua futura prática profissional.

Microbiological profile and antibiotic sensitivity of maxillofacial infections in an emergency hospital

Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy

Maxillofacial infections of dental origin: risk factors for hospital admission

Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length

Effect of electrochemically dealloying Ti6Al4V abutments on human gingival fibroblasts / 口腔疾病防治

Objective@#To investigate the effects of electrochemically dealloying of Ti6Al4V abutments on human gingival fibroblasts (HGFs) and to provide experimental evidence for surface modification of implant abutments.@*Methods@#The samples were divided into an NC group (negative control, no other treatment on a smooth surface), an NM-1 group (nanomesh-1, electrochemical dealloying treatment in 1 mol/L NaOH 1 h on 2 V voltage), and an NM-2 group (nanomesh-2, electrochemical dealloying treatment in 5 mol/L NaOH 1 h on 2 V voltage). The surface morphologies of the samples and the adhesion of HGFs on the sample surfaces were observed with scanning electron microscopy (SEM). The surface hydrophilicities of the samples were measured with a contact angle measuring instrument. The proliferation of HGFs on the different samples were evaluated with CCK-8, and the expression of adhesion-related genes, including collagen Ⅰ (COL1A1), collagen Ⅲ (COL3A1), fibronectin 1 (FN1), focal adhesion kinase (FAK), vinculin (VCL), integrin α2 (ITGA2), and integrin β1 (ITGB1), on the different samples was measured with qRT-PCR. The expression of vinculin on the surfaces of HGFs was observed via confocal laser scanning microscopy (CLSM) after immunofluorescent staining. Collagen fiber secretion and syntheses of HGFs from different samples were evaluated via Sirius red staining.@*Results@#SEM revealed the formation of ordered and uniform three-dimensional mesh structures on the surfaces of the NM-1 and NM-2 groups, with grid diameters of approximately 30 nm for the NM-1 group and approximately 150 nm for the NM-2 group. Compared with that of the NC group, the water contact angles of the NM-1 group and NM-2 groups were significantly lower (P<0.000 1). Cell proliferation in the NM-1 group was significantly greater than that in the NC group (P<0.01). Moreover, there was no significant difference in the water contact angles or cell proliferation between the NM-1 group and the NM-2 group. SEM revealed that HGFs were adhered well to the surfaces of all samples, while the HGFs in the NM-1 and NM-2 groups showed more extended areas, longer morphologies, and more developed pseudopodia than did those in the NC group after 24 h. qRT-PCR revealed that the expression levels of the adhesion-related genes COL1A1, COL3A1, FN1, FAK and VCL in the NM-1 group were significantly greater than those in the NC and NM-2 groups (P<0.01). The expression of vinculin protein in the NM-1 group was the highest, and the number of focal adhesions was greatest in the NM-1 group (P<0.01). The results of Sirius red staining showed that the NM-1 group had the highest secretion and syntheses of collagen fibers (P<0.000 1).@*Conclusion@#The three-dimensional nanomechanical structure of Ti6Al4V modified by electrochemical dealloying promoted the adhesion, proliferation, collagen fiber secretion and syntheses of HGFs, and electrochemical dealloying of Ti6Al4V with a grid diameter of approximately 30 nm obviously promoted HGF formation.

Epilepsias focales autolimitadas de la infancia / Self-limited Focal Epilepsies of Childhood

Resumen Las Epilepsias Focales Autolimitadas de la Infancia (SELFEs - siglas en inglés) son los síndromes electroclíni cos más prevalentes en edad pediátrica, cuya evolución típica, con inicio y remisión dependientes de la edad, ha permitido que el Grupo de Trabajo de Nosología y Definiciones de la ILAE (2022) las defina como "Epilep sias focales autolimitadas de la infancia", estableciendo así, criterios de alerta y exclusión para estandarizar su diagnóstico. Dentro de estos síndromes se incluyen: la Epilepsia Autolimitada con Espigas Centrotemporales (previamente Epilepsia Rolándica), Epilepsia Autolimi tada con Crisis Autonómicas. (previamente Síndrome de Panayiotopoulos), Epilepsia Visual Occipital Infantil (previamente Síndrome de Gastaut), y Epilepsia Fotosen sible del Lóbulo occipital. Ya no se recomienda utilizar el término "benignas" para referirse a ellas, ya que esto haría caso omiso de las comorbilidades que padecen algunos individuos. Asimismo, el término "idiopático" sólo se utiliza ahora para denominar a los síndromes clasificados como Epilepsias Generalizadas Idiopáticas.

Abstract Self-limited Focal Epilepsies of Childhood (SELFEs) are the most prevalent electroclinical syndromes in pe diatric age, whose typical evolution, with age-dependent onset and remission, has allowed the ILAE Nosology and Definitions Working Group (2022) to define them as "Self-limited Focal Epilepsies of Childhood", thus establishing alert and exclusion criteria to standardize their diagno sis. These syndromes include: Self-limited Epilepsy with Centrotemporal Spikes (previously Rolandic Epilepsy), Self-limited Epilepsy with Autonomic Seizures (previ ously Panayiotopoulos Syndrome), Childhood Occipital Visual Epilepsy, (previously Gastaut Syndrome), and Photosensitive Occipital Lobe Epilepsy. Using the term "benign" to refer to them is no longer recommended, as this would ignore the comorbidities some individuals suffer. Also, the term "idiopathic" is now only used to refer to the syndromes classified as Idiopathic General ized Epilepsies.

Epileptogénesis y corteza piriforme: entendiendo a la epilepsia del lóbulo temporal más allá del hipocampo / Epileptogenesis and the piriform cortex: understanding temporal lobe epilepsy beyond the hippocampus

Introducción: Con la experiencia de los registros electroencefalográficos invasivos y el fracaso quirúrgico después de la cirugía, se ha hecho evidente que la epilepsia del lóbulo temporal es mucho más compleja de lo que se creía, y en la actualidad es considerada una enfermedad de redes anatomofuncionales y no de lesiones estructurales. Contenido: La información neurofisiológica e imagenológica actual permite concluir que en esta epilepsia están involucradas varias redes neuronales temporales y extratemporales que contribuyen a la extensión de la zona epileptógena. Una forma de entender el concepto de red epiléptica en la epilepsia del lóbulo temporal es a partir del conocimiento de la corteza piriforme. Varios estudios clínicos han mostrado que en pacientes con epilepsia del lóbulo temporal asociada a esclerosis hipocampal existe una disfunción interictal del procesamiento olfatorio que es más significativa, en comparación con pacientes con epilepsia focal extrahipocampal y controles sanos. Esta alteración es, probablemente, la consecuencia de una red neuronal disfuncional que se extiende más allá del hipocampo y que afecta a otras estructuras cercanas, incluida la corteza piriforme. Conclusión: En este artículo llevamos a cabo una revisión narrativa de la literatura con el objetivo de establecer un vínculo entre la corteza piriforme y la epileptogénesis del lóbulo temporal, y demostramos que esta enfermedad es la consecuencia de una disfunción de redes neuronales que no depende exclusivamente de una anormalidad estructural en el hipocampo o en estructuras cercanas.

Introduction: With the experience of invasive EEG recordings and surgical failure after surgery, it has become clear that temporal lobe epilepsy is much more complex than previously thought, and currently, is conceptualized as a disease of anatomical networks instead of structural lesions. Content: The current neurophysiological and imaging information allows us to conclude that several temporal and extratemporal anatomical networks are involved in this type of epilepsy. One way of understanding the concept of the epileptic network in temporal lobe epilepsy is from the knowledge of the piriform cortex. Several clinical studies have shown that in patients with temporal lobe epilepsy associated with hippocampal sclerosis exists an interictal dysfunction of olfactory processing that is more significant compared to patients with focal extra-hippocampal epilepsy and healthy controls. This alteration is probably the consequence of a dysfunctional neural network that extends beyond the hippocampus and affects other nearby structures, including the piriform cortex. Conclusion: In this article, we carry out a narrative review of the literature with the aim of establishing a link between the piriform cortex and temporal lobe epileptogenesis, demonstrating that this disease is the consequence of a dysfunctional network that does not depend exclusively of a hippocampal structural abnormality.

Detection of focal lesions in the clot section with negative bone marrow aspirate and trephine biopsy—A series of 5 cases

Bone marrow aspiration and trephine biopsies are commonly used procedures in clinical practice. The practice of making a clot section by using the leftover blood from the bone marrow aspirate material is not a commonly followed practice across centers. A clot section has the advantage of studying the added material with an increased possibility of detecting focal lesions such as myeloma, lymphoma, granuloma, and metastasis in the bone marrow. Bone marrow aspirate, trephine biopsy, and clot section were compared for the detection of focal lesions in a series of 5 patients, 3 of who presented with a history of fever and 2 were already diagnosed cases of Hodgkin lymphoma. Focal lesions were detected in the 5 cases in the clot section alone, whereas bone marrow aspirate and trephine biopsy did not show any focal lesion. Granulomatous infiltration was detected in 3 patients, and lymphomatous infiltration was detected in 2 patients in the clot section, whereas bone marrow aspirate and trephine biopsy were negative for any focal lesion in all 5 cases. A clot section is particularly useful in the detection of bone marrow lesions with a focal distribution. Hence, it must be studied alongside bone marrow aspirate smears, touch smears, and trephine biopsy to increase the diagnostic yield.

Glomerular parietal epithelial expression of CD44 in minimal change nephrotic syndrome and primary focal segmental glomerulosclerosis: A clinico-pathological study

Introduction: Minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) are the two common causes of nephrotic syndrome (NS) in both children and adults with overlapping clinical features, but with distinct prognostic and therapeutic implications. The distinction between these relies entirely on histopathology, which can sometimes be difficult. CD44 is expressed by activated parietal epithelial cells, plays a role in matrix deposition and thus in the pathogenesis of FSGS. Aims: To assess the expression of CD44 in MCNS and FSGS and to evaluate its association with the known clinical and histopathological prognostic factors. Materials and Methods: Thirty cases each of MCNS and FSGS were studied. The clinical, laboratory, histopathological, and CD 44 immunohistochemical data were recorded. The findings were analyzed and correlated. A P value of < 0.05 was considered statistically significant. Results: Statistical association was noted between CD44 positivity and serum creatinine (p = 0.031), estimated glomerular filtration rate (p = 0.040), segmental sclerosis (p < 0.001), tubular atrophy (p = 0.027), interstitial fibrosis (p = 0.027), and histological diagnosis (p < 0.001). The sensitivity, specificity, positive predictive, and negative predictive values were 90%, 76.67%, 79.41% and 88.46%, respectively. Conclusions: CD44 immunostain can effectively distinguish MCNS from FSGS. The congruent results of CD44 positivity with known prognostic factors support the possibility of using the CD44 marker as a predictive tool in selecting high-risk patients and offering appropriate therapeutic measures.

Estado actual de la infección focal y del éxito del tratamiento endodóntico / Current status of focal infection and the success of endodontic treatment

Frente a la difusión en medios de comunicación de medias verdades con enunciados alarmantes y anticientíficos, este editorial busca revisar las bases científicas para determinar el comportamiento clínico. Así, el texto discurre por el concepto de infección focal desde su origen, yendo al encuentro de sus transformaciones conceptuales a través de los descubrimien- tos científicos, teniendo en cuenta las características emocio- nales propias de cada paciente como un todo y los peligros a los que se puede estar expuestos frente a las medias verdades (AU)

Facing the diffusion of alarming and anti-scientific state- ments in the media, this editorial seeks the scientific bases to determine the clinical behavior. Thus, the text runs through the concept of focal infection from its origin and across its conceptual transformations through scientific discoveries, by considering the emotional characteristics of each patient as a whole and the dangers to which they may be exposed in the face of half-truths (AU)

Estado actual de la infección focal y del éxito del tratamiento endodóntico / Current status of focal infection and the success of endodontic treatment

Resumen Frente a la difusión en medios de comunicación de medias verdades con enunciados alarmantes y anticientíficos, este editorial busca revisar las bases científicas para determinar el comportamiento clínico. Así, el texto discurre por el concepto de infección focal desde su origen, yendo al encuentro de sus transformaciones conceptuales a través de los descubrimientos científicos, teniendo en cuenta las características emocionales propias de cada paciente como un todo y los peligros a los que se puede estar expuestos frente a las medias verdades.

Abstract Facing the diffusion of alarming and anti-scientific statements in the media, this editorial seeks the scientific bases to determine the clinical behavior. Thus, the text runs through the concept of focal infection from its origin and across its conceptual transformations through scientific discoveries, by considering the emotional characteristics of each patient as a whole and the dangers to which they may be exposed in the face of half-truths.

Asociación entre índice de masa corporal y mortalidad en pacientes críticos con choque séptico / Association between body mass index and mortality in critical ill patients with septic shock

INTRODUCCIÓN. La paradoja de la obesidad propone que, en determinadas enfermedades, los enfermos con obesidad tienen menor mortalidad. OBJETIVO. Asociar el índice de masa corporal con la mortalidad a 30 días en adultos con choque séptico. MATERIALES Y MÉTODOS. Estudio observacional, analítico, retrospectivo, multicéntrico. Se analizaron 673 pacientes con choque séptico, ingresados en terapia intensiva de dos hospitales de la ciudad de la ciudad de Quito ­ Ecuador, durante enero 2017 - diciembre 2019. Criterios de inclusión: Mayores a 18 años, choque séptico, registro de peso, talla y condición vital al día 30. Criterios de exclusión: Orden de no reanimación, embarazadas, protocolo de donación de órganos, cuidados paliativos. Las variables se recolectaron a partir de las historias clínicas digitales y físicas de los centros participantes. Las estimaciones de riesgo calculadas se presentaron como OR (Odds Ratio) en el análisis bivariado y OR Adj (OR ajustado) para el análisis multivariado. Un valor de p <0.05 se consideró estadísticamente significativo. Todos los análisis estadísticos se realizaron usando el software estadístico R® (Versión 4.1.2). RESULTADOS. La edad promedio fue de 65 años, índice de masa corporal promedio 25,9 Kg/m2 (+4,9 Kg/m2). El 54,3% tuvo índice de masa corporal > 25 Kg/m2. La mortalidad general fue 49.2%. Sujetos con sobrepeso y obesidad tuvieron menor mortalidad, OR: 0,48 (IC 95%: 0.34, 0.68; p <0.0001) y OR 0.45 (IC 95 %: 0.28, 0.70; p =0.001) respectivamente, con similar tendencia en el análisis multivariado. Los sujetos con peso bajo tuvieron la mayor mortalidad (OR: 2.12. IC 95%: 0.91 - 5.54. p: 0.097). DISCUSIÓN. Los resultados obtenidos apoyan la teoría de paradoja de obesidad, sin embargo, no se realizó evaluación según los niveles de obesidad. CONCLUSIÓN. La mortalidad en choque séptico es menor en sujetos con sobrepeso y obesidad comparada con sujetos con peso normal o bajo peso.

The obesity paradox proposes that, in certain diseases, patients with obesity have lower mortality. OBJECTIVE. To associate body mass index with 30-day mortality in adults with septic shock. MATERIALS AND METHODS. Observational, analytical, retrospective, multicenter, retrospective study. We analyzed 673 patients with septic shock, admitted to intensive care in two hospitals in the city of Quito - Ecuador, during January 2017 - December 2019. Inclusion criteria: older than 18 years, septic shock, weight, height and vital condition at day 30. Exclusion criteria: Do not resuscitate order, pregnant women, organ donation protocol, palliative care. Variables were collected from the digital and physical medical records of the participating centers. Calculated risk estimates were presented as OR (Odds Ratio) in bivariate analysis and OR Adj (adjusted OR) for multivariate analysis. A p value <0.05 was considered statistically significant. All statistical analyses were performed using R® statistical software (Version 4.1.2). RESULTS. The mean age was 65 years, mean body mass index 25.9 kg/m2 (+4.9 kg/m2). Body mass index > 25 kg/m2 was 54.3%. Overall mortality was 49.2%. Overweight and obese subjects had lower mortality, OR: 0.48 (95% CI: 0.34, 0.68; p<0.0001) and OR 0.45 (95 % CI: 0.28, 0.70; p=0.001) respectively, with similar trend in multivariate analysis. Underweight subjects had the highest mortality (OR: 2.12. 95% CI: 0.91 - 5.54. p: 0.097). DISCUSSION. The results obtained support the obesity paradox theory, however, assessment according to obesity levels was not performed. CONCLUSIONS. Mortality in septic shock is lower in overweight and obese subjects compared to normal weight or underweight subjects.

Retinal laser – Protocols and practical tips

Background: Many a young doctors in training find retinal laser photocoagulation a daunting task. However, if correct protocols are followed and checklists are observed, then it is not difficult to have a successful laser sitting with a happy patient. Most of the complications can be avoided with correct settings and techniques. Purpose: To enumerate the basic protocols of retinal laser photocoagulation and provide practical tips including laser settings and checklists for hassle?free laser experience. Synopsis: Laser settings for a pan?retinal photocoagulation (PRP) for proliferative diabetic retinopathy differ from those for a focal laser for macular edema. A fill in PRP is indicated when an active Proliferative diabetic retinopathy (PDR) is seen after the initial PRP is completed. The settings and protocols for laser photocoagulation for lattice degeneration are different, and various techniques of barrage laser are discussed. Practical tips and checklists are given, which will not be found in any textbooks. Highlights: Animated illustrations and fundus photos are used to explain the correct techniques of performing laser photocoagulation in different indications and scenarios. Detailed instructions and checklists are provided, which can be very useful to avoid complications and medicolegal problems. The practical tips and guidelines in an easy?to?understand manner make this video highly educational for the novice retinal surgeons who want to perfect their technique of retinal laser photocoagulation.

Adenoma hepatocelular con captación de 18 flúor deoxiglucosa en PET-TC SCAN. Una "mini-review" e informe de un nuevo caso / 18-fluoro-deoxyglucose uptake on PET-CT in hepatocellular adenoma. A mini review with a new case Report

RESUMEN La captación de 18 FDG en PET-TC por un adenoma hepatocelular (HCA) es poco frecuente. Esta situación genera dudas en cuanto a los diagnósticos diferenciales y tratamiento. El objetivo de este artículo fue realizar una mini revisión de los últimos 37 años de HCA con avidez por el 18FDG y presentar un nuevo caso. Sobre la base de un estudio realizado por otros autores entre 1984 y 2014, se amplía la búsqueda utilizando las mismas palabras clave hasta el año 2021. Se analizan los datos relevantes. Entre 1984 y 2021 detectamos 38 casos en 37 años. Fue más frecuente en mujeres en edad reproductiva. Los subtipos H-HCA e I-HCA fueron los más frecuentes. El tratamiento quirúrgico fue el más empleado. La diferenciación celular y los trastornos metabólicos de la glucosa y de los lípidos favorecerían la captación de 18FDG. La resección hepática ofrecería mayores garantías permitiendo el estudio completo de la lesión.

ABSTRACT Hepatocellular adenoma (HCA) uptake of 18FDG uptake on PET-CT is rare. This situation poses doubts about the differential diagnoses and treatment. The aim of this article is to perform a mini review of 18FDG avid HCA over the past 37 years and to describe a new case presentation. Based on a study conducted by other authors between 1984 and 2014, we extended the search until 2021 using the same keywords. The relevant data were analyzed. Between 1984 and 2021 we detected 38 cases in 37 years. HCAs were more common in women of childbearing age. The most common types were H-HCA an I-HCA. Surgical resection was the treatment most used. Cell differentiation and glucose and lipid metabolic diseases would favor 18FDG uptake. Liver resection provides better outcomes, allowing for a complete examination of the lesion.

Glomerulopatía colapsante en un paciente con Covid-19. Reporte de caso / Collapsing glomerulonephritis in a COVID-19 patient. Case report

La injuria renal aguda por glomerulopatía colapsante, presenta alta morbimortalidad, incluso con requerimiento de diálisis crónica; la Covid-19 es una de sus causas. Se presenta el caso de un paciente con Covid-19 y glomerulopatía colapsante. Varón de 17 años, sin antecedentes patológicos; con historia de cuatro meses de edema, orina espumosa y disminución del flujo urinario. Al examen: anasarca. Exámenes: creatinina 4,2 mg/dl, albumina 1,9 gr/dl, colesterol y triglicéridos aumentados; orina: proteinuria 6,7 gr/24h, leucocituria y hematuria con urocultivo negativo. Serología para VIH, sífilis y hepatitis negativos. Inmunología para lupus negativa, prueba rápida para la Covid-19 IgG (+). La biopsia renal mostró Glomeruloesclerosis Focal y Segmentaria, variante Colapsante. Recibió corticoides y ciclosporina. La creatinina mejoró, la proteinuria se mantiene >3 gr/24horas.

SUMMARY Acute renal injury due to collapsing glomerulonephritis is associated with high morbidity and mortality, requiring chronic dialysis, COVID-19 is one of its causes. A 17-year-old male patient presented with a four-month history of edema, foamy urine and reduction in the urine flow; anasarca was observed at physical examination. Laboratory values showed creatinine 4,2 mg/dl; albumin 1,9 gr/dl; cholesterol and triglycerides were high; proteinuria 6,7 gr/24h: leucocyturia and hematuria with negative urine culture. Serologies for HIV, syphilis and hepatitis were negative. Studies for systemic lupus were negative. An antigenic test for SARS-CoV-2 was positive as well as an IgG. Renal Biopsy showed Focal and Segmental Glomerulosclerosis, Collapsing variant. He received corticosteroids and cyclosporine. Creatinine improved; proteinuria remained >3 gr/24 hours.

Amyloid spell – A close mimic of transient ischemic attack!

Transient focal neurological episodes, also called amyloid spells occur as recurrent, transient episodes of spreading paresthesia seen in 14% of cerebral amyloid angiopathy (CAA) patients. An 81-year-old gentleman with coronary artery disease and a left ventricular clot was on anticoagulant treatment. He presented with three episodes of tingling in the left fingers spreading to the left arm and left leg, each lasting for 10 min. Magnetic resonance imaging of the brain with susceptibility imaging showed convexity hemorrhage, and curvilinear blooming in sulcal spaces of the right cerebral convexity and left precuneus. Warfarin was stopped. He was treated with clobazam, aspirin, and atorvastatin. He improved, so was discharged after 2 days. Amyloid spells can be confused with transient ischemic attack (TIA) or its mimics and the treatment given for TIA can lead to intracranial hemorrhage in CAA patients. Radiological features aid in the diagnosis of CAA and antiplatelets need to be administered cautiously in patients with suspected TIA.

Bilateral tongue fibrous hyperplasia: A case report and literature review / Hiperplasia fibrosa bilateral de língua: relato de um caso e revisão daliteratura

Focal fibrous hyperplasia (FFH) is a pathology characterized by tissue enlargement as a result of increasing the number of inflammatory cells which receive chronic mechanical stimuli of low intensity that may affect gums, lip, palate, jugal mucosa and tongue.The aim of this article is to report a case of FFH on the lateral border on both sides of the tongue associated with the use of the Hyrax appliance in a hebiatric patient, whose chief complaint was chewing discomfort. This case was diagnosed clinically and by histopathology analysis and treated by surgical excision as well as the removal of Hyrax appliances. Follow-up care provided the recovery of the patient's quality of life.

La hiperplasia fibrosa focal (HFF) es una patología caracterizada por el aumento de tamaño de los tejidos como consecuencia del aumento del número de células inflamatorias que reciben estímulos mecánicos crónicos de baja intensidad que pueden afectar a encías, labio, paladar, mucosa yugal y lengua. El objetivo de este artículo es reportar un caso de FFH en el borde lateral a ambos lados de la lengua asociado al uso del aparato Hyrax en un paciente hebiátrico, cuyo principal motivo de consulta era la molestia masticatoria. Este caso fue diagnosticado clínicamente y por análisis histopatológico y tratado mediante escisión quirúrgica así como la retirada de los aparatos de Hyrax. La atención de seguimiento permitió la recuperación de la calidad de vida del paciente

Cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal: ¿cuál es el impacto sobre el riesgo de infección? / Routine change of surgical instruments and gloves in abdominal surgery: what is the impact on the risk of infection?

Objetivo: Analizar la evidencia más actualizada sobre el cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal, y su impacto en el riesgo de infecciones. Métodos: Se realizó una búsqueda bibliográfica, en las bases de datos PubMed, ScienceDirect, Web of Science, y MEDLINE. Resultados: A la fecha, la evidencia sumamente escasa sobre el potencial impacto del cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal, y su relación con la incidencia de infección en el sitio operatorio. Sin embargo, no deja de ser un tema de interés en cirugía global. El estudio ChEETAh, ensayo realizado en siete países de bajos y medianos ingresos, que evaluó el cambio rutinario tanto de guantes como de instrumental quirúrgico en cirugía abdominal y su relación con la infección, demostró que, la frecuencia de infección en sitio operatorio fue del 16% (n=931) en el grupo intervención, comparado a un 18,9% (n=1280) en el grupo control (RR 0,87; IC 95%: 0,79 ­ 0,95; p=0,0032). Así, podría existir cierta protección adicional con el cambio rutinario de guantes e instrumental en cirugía abdominal. Conclusión: Aunque la evidencia es limitada y heterogénea, existe una tendencia respecto a un potencial beneficio frente a la incidencia de infección en sitio operatorio, en el cambio rutinario de guantes e instrumental quirúrgico en cirugía abdominal(AU)

Objective: To analyze the most recent evidence regarding the routine change of surgical instruments and gloves in abdominal surgery and its impact on the risk of infections. Methods: A literature search was conducted in the PubMed, ScienceDirect, Web of Science, and MEDLINE databases. Results: To date, the evidence regarding the potential impact of routine changes in surgical instruments and gloves in abdominal surgery and their relationship with the incidence of surgical site infections is extremely scarce. Nevertheless, it remains a topic of interest in global surgery. The ChEETAh study, conducted in seven low and middle-income countries, which assessed the routine change of both gloves and surgical instruments in abdominal surgery and its relation to infection, demonstrated that the frequency of surgical site infection was 16% (n=931) in the intervention group compared to 18.9% (n=1280) in the control group (RR 0.87; 95% CI: 0.79 ­ 0.95; p=0.0032). Thus, there may be some additional protection with the routine change of gloves and instruments in abdominal surgery. Conclusion: Although the evidence is limited and heterogeneous, there is a trend suggesting a potential benefit in reducing the incidence of surgical site infections through the routine change of gloves and surgical instruments in abdominal surgery(AU)

Hypertension from the patient's perspective: contributions to the care offered by health professionals and self-care - a qualitative study

ABSTRACT BACKGROUND: Hypertension is the most common disease in primary care settings. Only 30% of cases were adequately controlled. OBJECTIVES: To analyze the knowledge and understanding of patients with hypertension regarding the factors that facilitate and limit adherence to treatment and, based on the results, build specific guidelines on hypertension self-care and control. DESIGN AND SETTING: This qualitative study was conducted in a primary healthcare setting. METHODS: Patients with hypertension who were followed at a primary healthcare unit were interviewed through focus groups, and a qualitative interpretation of their statements according to Bardin's content analysis was performed. RESULTS: Three focus groups were formed (21 participants), from whose analysis emerged 74 core ideas related to the concept of hypertension, causes of increase in blood pressure, clinical consequences of hypertension, and possible patients' contributions to help control blood pressure, arising from eating habits, psychosocial conditions, and lifestyle. Patients tend to accept the concept of "high blood pressure" as an inherent condition of the disease in their lives. Eating habits are strongly related to life history and self-perception of health. The association between high blood pressure and nervousness or stress appears to be strong. CONCLUSION: The experience of having "pressure problem" is unique for each person. It is necessary to optimize listening, recognizing that, for the patient to understand what hypertension is and its management, there must be understanding and convergence of proposals, adjustments, and changes in a positive and personalized way. As a result of this study, we implemented educational actions in primary healthcare units.